Here are some common scenarios that I encounter frequently:
Patient books a standard consultation (10-15 minutes depending on the practice), but..
The patient then comes up with a shopping list of problems that they want solved then and there itself. The doctor then offers to discuss these issues during another consultation. Many patients will be reasonable about this, especially after the doctor explains that in order to offer quality care, the ideal consultation involves a number of steps for each issue, including taking a relevant history, performing a relevant examination, explaining the possible differential diagnoses, and offering a variety of treatment options. However, there are also many patients who choose to respond with aggression, often using one of the following arguments:
- “I have never met a doctor who refused to address more than one issue at a time” <– I’m sure you haven’t. They must have solved your life story in 10 minutes.
- “but this is the main reason I came in today” <–which is why you mentioned it at the end of the consultation
- “how rude” <–offering an explanation is considered reasonable and polite.
The moment the doctor informs them that it will cost them more, they tend to opt to book another appointment, or disappear all together. Win win situation.
“It should all be on the record. I’ve been through this with others before”
Yes, I do understand it can be frustrating to have to explain a problem more than once. However, there are many reasons why a doctor you’re seeing for the first time should take a proper history from you:
- It may not all be on the record. This could be because not all notes have been transferred from another clinic, or not all the information you discussed with another doctor in the same clinic may have been documented.
- If there is a library of notes about you, it’s really not prudent to review in detail every note and correspondence prior to your arrival. This can not only be time consuming, but your presenting problem may have nothing to do with what’s on record. If you go to the library looking for a specific book, you can enquire about it with the librarian, and she can look up the relevant section and point you in the right direction. The librarian will not go through every book on the shelf prior to a patron making an enquiry. The GP setting is no different. Just as a librarian has to know what sections are stocked where in the library, it’s good practice for a GP to familiarise themselves with a summary of your relevant medical conditions prior to a patient visiting them. Once the patient opens up about a specific problem, the GP can then focus on evaluating that particular problem in the overall context, and retrieve the relevant available correspondence.
At the end of the day, transparent two way communication and cooperation from both parties translate to improved healthcare outcomes.
More to come on expectations..