Diurnal variation

Two old friends spot each other in the cafeteria of their local hospital. They know one another well enough, and have lived long enough, not to be embarrassed about being seen, but they keep the details of their medical complaints to themselves. So they talk about the doctors – in general terms.


Dorothy begins.

“He was charming, sunny, very reassuring. He made time, he asked me about myself, what I used to do for a living. I was very impressed. On time too, though it was early. What about yours?”

“Very different, I’m sad to say. I don’t know how some of these people get into medical school. He looked like he didn’t want to be there, couldn’t help but look at the time every two minutes. His mobile phone kept vibrating and when it did he would look sideways at the message. I didn’t have a very complicated problem, but I was worried…and he was just so…functional. You need this, you need that. Didn’t ask me how I felt about it even though I must have looked sacred. Might as well have been talking to a computer, to be honest.”

“I’m sorry to hear that. Just shows, all sorts can become a doctor. I bet your one is very clever…one of those smart but cold types. Whereas mine was smart and nice!”

“Well I wasn’t impressed.”

“Perhaps he was having a bad day. Or perhaps he just needed his lunch.”

“No excuse for making me feel like a pest is there?”

“Oh, don’t look now, but here he comes now. My doctor, just behind you.”

Dorothy’s friend looks around anyway, and frowns.

“Hang on, that can’t be right. That’s the doctor I saw!”


The point of this tale?


Patients form distinct impressions of their doctors on the basis of single, brief interactions. Those impressions endure, and it is inevitable that assumptions regarding the doctor’s compassion, level of interest in the whole person and overall ‘goodness’ will be made. But that doctor may well present himself differently according to circumstances – their current state of physical or mental fatigue, their response to unexpected stresses (or text messages!), or lingering regret over the fate of their last patient. Some doctors are more capable than others of maintaining an aura of equanimity, whatever the pressure, however late the clinic is running. Others respond more visibly, expressing interest in people when they are genuinely interested, but failing to disguise a sense of distraction when situations outside the room cause their minds to wander.  Combining a ‘professional’ exterior with the ability to express genuine warmth and be interested is a complex skill.


Anyone working in a people-facing occupation will have experienced the same phenomenon, that of presenting a variety of personalities during one working day or shift. In medicine, the consequences of such variation can be very significant indeed.





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