A little over twenty years ago, a colleague of mine wrote a moving article, ‘You lie there naked. Lessons from a lesion.’ Booster as he was fondly called, a vivacious medical student at the time was diagnosed with lung cancer and was admitted in hospital for surgery. That article was his reflection on the experience of being on the ‘business end of the stethoscope’.
Over the years, we have heard different stories told by patients after a visit to the doctors.
‘I’d hardly told him my problem before he wrote a prescription and sent me out….’
‘She didn’t even look at me. Her eyes were glued to the computer throughout the consultation…’
With experience on both ends of the stethoscope, this article explores some of the issues around patient-doctor consultation especially in the UK with the hope that your visit to the doctor’s surgery from now on will be mutually satisfactory.
1) Booking an appointment
Many patients complain that it is virtually impossible to see their doctor.
‘The receptionist will advise you to call first thing in the morning. When you call at 8.30 a.m. the line is permanently engaged. By the time you get through she tells you there are no more appointments!’
While this may be true in some practices, at times patients who have not contacted their GP in a year will tell the same story, not realising that things may have changed. Whatever the situation, there are some options. In many cities, there are Walk-In Centres (WIC) where you do not need an appointment. For simple ailments, ‘Paracetamol, fluids and rest’, the local pharmacist or a WIC may be all that is required. In addition, it may be faster to book with the Nurse Practitioner. If she has any concerns, she could probably get you to see your GP faster.
2) Preparing for the appointment
Many people do not prepare for their GP appointment. They just turn up. You have heard the statement, ‘fail to prepare, prepare to fail’. You have only ten minutes for a consultation and many things can go wrong on the day if you are not prepared. The first question your doctor wants to answer is the reason for your visit. I usually ask my patients, ‘What can we do today?’ or ‘What is the problem?’
It is a good idea to make a list of your problems. Even if you have ten symptoms, make an effort to list them according to felt importance. Some doctors will hear your first complaint and take over the conversation from there. Few surgeries have a sign, ‘If you have two complaints, book a double appointment.’ Your fever, headache, cough and catarrh may be related. Nevertheless, plan to discuss your number one concern first, not last! A good doctor will try to find out what your ‘hidden agenda’ is. Think about it. Ask yourself the question, ‘What do I really want from the doctor?’ and prepare to share the answer. Apart from the coughs and cold symptoms, think about emotional, work and family issues which may also present as physical symptoms. Prepare to mention these if relevant. If you need to discuss a medication, you can take it with you. Very few doctors know what ‘that small yellow tablet’ is. If you have recently been discharged from the hospital, don’t leave the discharge letter at home because your doctor may not have received a copy.
You can write a brief aide memoire and take it with you so you don’t beat yourself when you walk out of the consulting room.
3) Waiting for the appointment
Time management is very important. Many doctors are turned off by a patient who is late for an appointment. Some people are perpetual late comers. Depending on your practice policy, you may be turned back if you arrive late. Think about it. If you arrive five minutes late for a ten-minute appointment, you will probably take up the next patient’s time and set off a vicious cycle. Please plan ahead and arrive in good time. Remember to take a dose of patience with you. Be courteous to the Receptionists. They are usually on the receiving end of patients who can’t get appointments, whose lab results, hospital appointments or repeat scripts, etc are not ready. A courteous smile from you could make all the difference in their day. Don’t be grumpy and tell everyone who cares to listen how terrible the practice is because the doctor is running late. There are many reasons for a clinic running late, some of them out of the doctor’s control – computer or printer fault, a depressed patient, one with multiple problems. A ten-minute appointment can easily turn to half an hour if the patient ahead of you needs hospital admission – the consultation, contacting the on-call doctor, writing the referral letter, speaking to ambulance control room and so on all take time. It may not simply be because the GP is too slow.
4) The Consultation
Finally, it is your turn. You have planned ahead and prepared your story. You have waited patiently. You’ve got ten minutes, don’t waste them! A few years ago, I went to see a dentist. All I could say when asked was that my front lower tooth ‘didn’t feel right’. Nothing else. The dentist was frustrated at my lack of detail. They did an x-ray of the tooth, found out it was dead and I later went through a procedure called root canal therapy to remove the dead contents of the tooth. It is not that simple when you see your doctor. A few tips here on what make a good consultation.
Many years ago, the doctor was the boss. You simple did as you were told. In this part of the world, things have changed a great deal, perhaps for the better. When you consult your doctor, it is increasingly an equal partnership. To start with, the doctor will attempt to establish a rapport with you. Try and put yourself in his position. Be courteous and relaxed. Tell your story when invited. You don’t have to be apologetic. You are not disturbing him or her. On the other hand, you are not a customer, you are a patient. Remember to talk about the most important symptoms first. Don’t ramble, do your best to go straight to the point. Describe the pain you have now first and not talk endlessly about a similar pain you had five months ago! Remember to share your ideas – what you think the problem is, your concerns – e.g. if you think the headache will lead to stroke and your expectations – if you are convinced only antibiotics will clear the cough, or the back pain is so bad that you can’t go back to the factory and want a sick note. If the symptoms are affecting your life at home, at work and at play, volunteer the information. Some doctors will not remember to ask. If it is important, with good planning, you can communicate the information.
You will probably have to answer some questions as the doctor ticks important boxes along the story line. You may undergo an appropriate physical examination but you must be offered a chaperone for intimate examination e.g. front and back passages for both sexes, and the breasts in women.
When the doctor has formulated a working diagnosis, it should be explained to you in plain English. You will probably be given management options and asked to choose. Don’t look lost or say ‘Are you not the doctor?’ Instead, be prepared to contribute to the management plan. If you think your blood pressure should be checked, you can ask politely. If a wise friend had told you that you should have blood tests, etc, ask your doctor if they are necessary.
At the end of the consultation, be clear about the plan of action. If there are lifestyle issues, do take them seriously. If you are given medication you should be told how to take them: before or after food, time of day, side effects and if it is alright to take with your current medication (if any). If you are not told, ask to know when you should feel better, what to do if things get worse and when to return if a follow up is necessary. If a blood test or referral to another health professional is agreed, be certain about what you are expected to do prior to your departure. Never leave the consulting room without knowing the working diagnosis, treatment and follow-up plan for your consultation.
All said and done, if you smoke and won’t quit, drink a lot and keep up with your binges; if you are addicted to your sofa and late night TV, insist on fish and chips and forget to take your medicines, you should not blame your doctor or the NHS for your failing health.
To sum up,
Prepare to tell your doctor the problem that matters most and what you hope to get out of the consultation
Arrive in good time, be polite to the staff and be patient if the surgery is running late
Do your best to honestly tell the doctor the most important symptoms, your thoughts about the cause, your worries and what you hope to get out of the visit
Be clear about the diagnosis, planned investigations, treatment, referral and follow up plans
Look after yourself.
Dr Hector is a GP in Leeds, UK with keen interest in lifestyle intervention and community coalitions for health. He is a Director of KayHector Consulting Ltd, which coordinates health checks, second medical opinion and medical referrals for health tourists to UK and other countries.
(info@kayhector.com)