Wednesday, 18 September 2013

Jumping to conclusions

Oh no!
It is well known that GPs make very quick judgements about patients right from the moment the patient gets up out of the waiting room chair, whether with a sigh or a groan or a glum expression. Multiple thoughts pass through the physician's mind. Perhaps a prediction of a request for a sickness certificate (OK they are not called that now), or a concern that the consultation is going to be long and draining. And with 10 minutes per consultation, speed of thought is necessary.

This morning I saw a man who had spoken to me on the phone the previous day. He had experienced some blood in his urine and was naturally concerned. I arranged to see him first thing and asked him to bring two urine samples. Now men have a habit of bringing rather unusual containers for their samples, whether it be the traditional Lucozade bottle or the wife's empty perfume bottle, or even an old style milk bottle. So I was somewhat concerned when I saw him clutching a John Lewis bag with a large container outlined within it. I had visions of having to carefully decant the large bottle into appropriate containers, no doubt spilling some urine down the sides in the process. So what joy when the contents ere revealed-two universal containers compete with urine, and a bottle of Spanish Gran Reserva.

Oh joy!
How many difficulties would be lessened if we learned to not be hasty in our judgements, whether it be patiently listening to a faltering patient who finds it hard to express themselves, or assuming that all patients with similar symptoms need similar treatments or just being in that hurried state that so many of us get ourselves into when we are not managing ourselves very well.

At root of this difficulty is what has been popularly called 'hurry sickness'. GPs are particularly exposed to this, especially with an increasing number of opportunities for measurement and advice (much of which is urged by the DOH),  which are present in every consultation. Whether it be height and weight, smoking status, advice on longterm contraception, enquiry about vaccination, 'lifestyle advice...and that all before the poor old patient has had a chance to say anything! No wonder many GPs feel stressed. Somehow we have to learn to take the pace off the consultation, rather like a top batsmen coping with a very fast bowler-not by hitting straight back over the bowler's head, but by guiding the ball with soft hands on the bat, using the of pace the ball generated by the bowler. So don't try to accomplish everything in every consultation, allow the patient to speak, try to prioritise what is achievable, and don't jump to conclusions!
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