PI Brief Update

Are Doctors Arrogant? - Dr Mark Burgin

24/08/26. Dr Mark Burgin explains why professionals can appear out of touch with reality and lack humanity.

Doctors do not start out believing that their job is to block patients from obtaining effective treatments. Over time their idealistic beliefs in healing and providing comfort are eroded. They come against the systemic barriers that creates fear, frustration and defensive practice. The turnover of doctors due to moral injury is high but this begs a chilling question - which doctors are the ones who stay?

Patients often have illnesses that are difficult to manage because the system is dysfunctional. For instance, a person with acute pain from a known disease requires prompt pain relief. This should be a moderate oral painkiller, review after a short period and step up to strong IV painkiller. What happens is that they cannot decide to give any painkiller, so the person sits in A and E for hours in pain.

Doctors know that it is their responsibility to provide medical care to their patients, the patients feel frustrated that the doctors do not give even obvious treatment. When the patient leaves A and E after 12 hours still in pain and makes a complaint the hospital simply responds with ‘the patient left before treatment’. Blaming the patient for their response means that patients are unlikely to return unless they are desperate.

Cancer

Cancer has a high mortality rate so if a patient gets the wrong treatment it is difficult to prove that they were harmed. The defendants can argue that there was medical breach but they are not liable. Loss of a chance means that the patient would need to move from over 50% success to below 50% for the treatment. Cancer is unpredictable and often causes death when the treatment is ideal.

An oncologist should consider a treatment using BRAN (benefits, risks, alternatives and no treatment). Drugs like PARP inhibitors slow but do not change the ultimate trajectory so they should be given as early as possible. It is not clear who will benefit so the patient should decide whether to take the risk. Treatments to help with the complications of cancer such as nutritional are available and in some patients can be life changing.

As the benefits are generally to quality rather than quantity of life they are not offered. The benefit of cancer drugs in symptomatic advanced cancer is limited and the harm is 100%. It is not uncommon for a patient to be offered a highly toxic chemotherapy and refused palliative care in the form of intravenous food. Palliative care is considered to be a Cinderella service - underfunded and overlooked despite the much higher effectiveness of these treatments.

Medically unexplained symptoms MUS

GPs can usually identify the likely cause of a symptom and provide an explanation. The patient can use that information to test out different approaches and learn to self-manage. The breakdown of trust that occurs if the GP trivialises the symptom and dismisses the patient’s experience is a common cause of unhappiness. Paradoxically the GP will often have investigated the symptom intensively ‘to reassure the patient’.

To understand what is happening we need to consider what MUS means, the GP is saying that they do not understand the symptoms. Patients accept that the GP may not find a diagnosis but should be able to explain the symptoms. If a patient has irritation of the eyes the GP should be able to say that the pain receptors are being irritated even if they do not know what is causing the irritation.

Patients who feel fobbed off will look up their symptoms online and then return with a list of tests or treatments that they wish to try. The GP who tries to argue that they have ruled out those problems cannot persuade the patient. By giving up and accepting that they do not understand the symptoms they have lost the trust of the patient. The patient will interpret any GP actions as being too proud to admit that they are wrong.

Arrogance as a Shield

We have examined three of the common situations where the patient does not get appropriate and commonsense care. A and E is frightened of giving painkillers, cancer treatments favour toxic chemo over palliative care and GPs do not explain the symptoms. The doctors appear aloof, dismissive and rigid rather than admit that they have made an error. They use descriptions such as the heartsink patient which blames the patient rather than their limitations.

One cause of arrogant behaviour is that the system punishes good behaviour with inappropriate targets. A GP who explains the problem so that the patient can self-manage is criticised for working slowly. The oncologist’s funding for supportive treatments runs out more rapidly than for high-cost chemo. Managers complain about drug seeking behaviour in A and E and doctors learn to do what is expected.

Another issue is that it is much easier to fob off a patient than to address their needs. They will often see a colleague or come back when the problem is clearer (and the window of opportunity is closed). Referring for tests or to another doctor is quick and simple compared to listening and examining the patient. Patients whose problems have not been solved will become more complex each time they return.

Conclusions

I do not blame individual doctors for failing their patients nor do I blame patients for having expectations. Sometimes it is possible to help patients persuade their doctors to change course. However, I often recommend that patients bypass the systems by going privately during the window of opportunity. Paying a couple of hundred pounds for a test or consultation can unlock a different path worth thousands.

The doctors who remain in the NHS describe being traumatised by their experiences of refusing treatments. They may appear arrogant but under their mask they have burn out and learned helplessness. Even when the patient returns following successful diagnosis and treatment they will fail to accept that they were wrong. They cannot learn from the experience and will repeat the error again in the future.

The answer is not to remove arrogant doctors or to train better doctors as this is already happening. The extraordinary turnover of GPs means that most new doctors only stay in practice for an average of 5 years. What needs to change is that managers accept that staff happiness is the only measure that has been proven to lead to better outcomes. Medical leaders need to listen to patient advocacy groups and support attempts to provide the services that they are campaigning for.

Doctor Mark Burgin, BM BCh (oxon) MRCGP is a Disability Analyst and is on the General Practitioner Specialist Register.

Dr. Burgin can be contacted on This email address is being protected from spambots. You need JavaScript enabled to view it. and 01226 761937 websites drmarkburgin.co.uk and gecko-alligator-babx.squarespace.com

This is part of a series of articles by Dr. Mark Burgin. The opinions expressed in this article are the author's own, not those of Law Brief Publishing Ltd, and are not necessarily commensurate with general legal or medico-legal expert consensus of opinion and/or literature. Any medical content is not exhaustive but at a level for the non-medical reader to understand.

Image ©iStockphoto.com/Hiraman