I should start by saying that I like my patients – even the ones that are difficult. I don’t want anyone to think that this is just another rant by an arrogant doctor complaining that his patients are hard work. The hardest patients are often the most rewarding.
But my job is busy. Today, for example, I saw 29 patients, visited one at home and had telephone consultations with 4 more. On top of that there were 23 letters, 26 prescription requests and 34 blood results waiting for me when I got into work this morning.
Each one of them takes time and concentration. Some are fairly quick but others take much longer; the number of patients with complex health needs is increasing. At one point this morning I was running half-an-hour behind.
Please don’t misunderstand me, I am not complaining about any of this. I love my job. But that doesn’t mean it isn’t hard.
So much to do, so little time…
In order to do my best for everyone I need to be organised and run roughly to time (a half-an-hour delay isn’t actually that bad).
In a 10-minute consultation, time is tight. Most patients will talk for at least a minute before I can ask any more questions. In the nine that remain, I need to understand the patient’s story, examine them, formulate a diagnosis and management plan, write a prescription and/or request some further investigations, like blood tests and x-rays. I must then communicate all of this with the patient and make sure they understand.
I only have time for one problem
I have lost count of the number of times patients have mentioned another problem, just as I had been about to say goodbye.
It is usually “just one more thing” or “there was something else as well, doctor” asked in a hopeful, sometimes pleading way. The one I can’t stand is “while I’m here” as if I exist entirely for their convenience.
However they say it, my heart sinks. At that point in the consultation I have already mentally moved on to the next patient. The cogs in my head take a second to adjust.
Just tell them to f*** off
I know that there are lots of GPs who will very firmly, even to the verge of rudeness, inform the patient that they can only deal with one problem per consultation, and that they will have to re-book.
There are three reasons that I don’t say that myself:
- I have a natural curiosity in people’s illnesses. Could these new symptoms be related to the ones we had just discussed? If so, then the new information could be the key to making a diagnosis
- On two occasions in my career a patient has said to me, “And another thing doctor: I’ve been getting this heavy pain in my chest that goes into my left arm”. Both patients were having heart attacks.
- I am far too polite for my own good.
So when you next see your GP stick to one problem, book a double appointment or tell them upfront that you have several issues, so at least you can decide together how to approach them. Write a list if that helps you remember.
Limiting the time you spend with your GP will mean that someone else can get a bit more. After all, there is always someone who needs help more than we do.