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Be concise, don't expect miracles – and know when to stay away. Dr Pauline Brimblecombe on how to get the best from your GP
Tuesday, 28 October 2008
Who'd be a GP? Unfortunately, we family doctors have a bad reputation at the moment. The Government doesn't like us because we got a massive pay rise and now they're painting us as lazy fat cats whom patients can never get to see. Meanwhile, we are as busy as ever. So why do we put up with it? Why have I put up with it for 25 years, seeing up to 60 patients a day? Because we care about patients. The relationships we form keep us going. I've got patients who I've seen as children and who are now married and bringing in their own children.
But a GP's job can be a frustrating one, andthere are things we can all do to be a better patient and get better care. Here is my 10-point guide to a better experience in the surgery.
Get to the point
The worst cases are where people come in with something minor such as a verruca on their toe. You think, "Great. I can treat that in two minutes and use the rest of the time to catch up and do their blood pressure or talk to them about their smoking." Then, just at the end of the consultation, you ask, "Is that all?" They turn around and say, "Well, while I'm here, doctor..." and it turns out they're suicidal or have a lump in their breast, something you've got to sort out there and then. Some patients are good at communicating, but others get flustered because they're worried. We could listen more and wait for the real reason to surface, but it's always best to come in and tell us exactly what you're worried about.
Be prepared...
Each of my patients gets 12 minutes with me, and most GPs offer appointments of between 10 and 15 minutes. It's more than the five minutes we used to have, but it's still important to prepare to get the best out of the time. It's so frustrating for a patient to leave the surgery not having had all their questions answered, or for the GP to sit there knowing they haven't got to the patient's agenda. We used to dread patients coming in with lists, but it's actually quite a good thing to do, because we can sit down and prioritise, working as a partnership. Or even when you're sitting in the waiting room, have a think about exactly what you're hoping to get out of the consultation.
...But not too prepared
Working in Cambridge, half my patients are Nobel Prize winners while others think they know everything because they've Googled it. There's a huge amount of information online, but it's not always put into context. That's our job. Another problem is people who are used to something different. I had a patient from another country who came in with hay fever. She said that in her country, she was treated with monthly injections for five years. I told her that in this country we prescribe a nose spray and anti-histamine tablets. She looked at me as if she thought the NHS was some kind of backwater, but we don't like to do things that are unnecessary. I used to get more upset when patients came in with things from the internet, but now I almost expect it – if it makes patients more interested, then they're more likely to take control and look after themselves.
Chances are...
We're very bad at assessing risk. People hear that everybody should have a cholesterol test or a test for prostate cancer and they've looked it all up and booked an appointment. But it's important to assess your own risk. Say there's a media scare about the pill suddenly doubling the risk of breast cancer. Everybody thinks, "Oh, my god, I'm going to get breast cancer," and they come in. Yet we all know that while buying 10 lottery tickets increases the chance of winning tenfold, 10 times bugger-all chance is still bugger all. We're terribly aware of things we see on the news or in the papers. If there's a bird flu or Sars scare, you can be sure that the phones will start ringing, even though the risks are minute.
There's no magic wand
Most people rather like things being done to them. They want to be prescribed some tablets or be given a test or a referral. The problem is they are not always necessary. Resources are finite, and medicine, which can be dangerous, should never be taken without a good reason. Yet if people go into the doctor and all they get is advice, they sometimes feel short-changed. They shouldn't: the majority of patients we see have self-limiting illnesses, things that will get better in spite of what we do.
Think before you book
People don't always see us as a resource because we're free. If you had to pay £25 to see a doctor about a cold, would you do it? People have also become very intolerant of minor illnesses because we have a pretty healthy society. Flu is the worst thing that ever happens to most of us and even then very few people have proper flu. The most common thing I get is people coming in with a runny nose and a cough. I look at them and say, "Well, what were you hoping I was going to do for you?" They look rather upset sometimes. Then I ask what have you done for yourself and sometimes it's nothing. We don't want to stop people with real concerns coming in, but there are so many other resources we can use: NHS Direct; pharmacists; and, used sensibly, the internet. Lots of surgeries now also do phone triaging. People who are not sure if they need to come in can phone up and ask for advice.
Your child is ok (probably)
Children are difficult to treat because they get ill very quickly and recover very quickly. And these days we don't get the big families with mothers who've seen it all. Now families might have one or two children and I often get mothers who are very worried about their child, automatically thinking the child has something terrible. Meanwhile, the child will charge about my consulting room pulling things off shelves and jumping on the scales. But you have to look at the child as a whole. If they've got a temperature or a rash but are still running around, chances are there isn't much wrong with them. Of course, if you are worried, we're very happy to look at children and send you on your way, but being a good parent is not always about bringing the child to the doctor with every sign of illness. Oh, and one more thing: please don't leave dirty nappies in my waste bin.
You don't have to come
Of course, there are certain screening tests we encourage people to come in for, but if you're fit and healthy and don't smoke or drink excessively, then enjoy it and stay away. I know people who haven't been to see their GP for decades, and there's not necessarily anything wrong with that. It's amazing how many people come in and say, "Oh, well, I made the appointment early in the week because I had a cough but I'm better now but thought I'd come anyway." Cancel!
Don't be too good a patient
A lot of elderly patients in particular think that being a good patient is important even if it means pretending to take tablets. Often when we go into a patient's house on a home visit, or after they have died, we've found cupboards full of pills. It's a tragic waste of time. If you're not happy with what the doctor is offering, then share your concerns. Also, in my surgery we say beware patients bearing gifts. It can make us feel that they expect something even if they don't. The best thing is to write a little thank-you note. That's really important to us because everybody tells us when we're doing something wrong and it's really nice to hear we've done something well.
Wash your feet
If you've got a problem with your feet, then wash them before you come, but don't worry too much – hygiene bothers patients more than doctors. We're pretty immune, and at the end of the day you haven't always got time to go home and have a wash before you come in. If you can, then great, but if not it's not as if we're going to kick you out. We take all-comers – that's the most important thing about general practice.
Dr Pauline Brimblecombe is a GP in Cambridge. She was talking to Simon Usborne
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