Friday, 9 September 2016

The Long Goodbye

No, not the Raymond Chandler novel from 1953 (an auspicious year), but my decision to retire from Cobbs Garden Surgery where I have been a partner since 1983. Sometime between the end of this year and February 2017 I wont be making the daily short commute to Olney. I'll be sad.

So I'm going to try to blog moire frequently about things that I have picked up along the way which I hope might be of some interest, especially to other GPs who feel equally passionately about the uniquely privileged job we have.

In the popular mind our work consists of dealing with sore throats, coughs and colds and sickness certificates (or fitness certificates as they are now called-a rose by any other name). In fact a fair proportion of our work is about explanation or clarification. What does condition X mean? How worrying is it? Should I go for this treatment or that, or none at all? Etc, etc.

Today I fielded a phone call from a very concerned patient who had received a copy of a letter from the local hospital written to me (I have to say I'm not a fan of the copied in letter between health professionals). At the head of the letter was written the various diagnoses, as is standard in such letters. He was alarmed to read the words, 'malignant neoplasm of....'. 'But I was told I no longer have cancer, now it sounds as though it's spread'. It was the word malignant that had struck fear. Sticks and stones may break my bones but words will never hurd me, was often heard when I was a lad. Oh yeah?  How consistently untrue that proverb has proved to be!

My patient felt that malignant meant that the cancer had spread, and anyway why was he still listed as having cancer when the specialist had told him it had all been removed? I tried to simply explain that noting his diagnosis was a record of his medical past which did not necessarily mean the condition was currently active (although it is an alert to the clinician that the recorded diagnosis may be relevant to the presenting problem). No, malignant did not mean spread (I think he was confusing the word with metastases), and neoplasm was just another fancy word for abnormal growth (which can be benign or malignant!).

All to say, if you are communicating with patients, especially when writing to a fellow health professional, be aware that the words you use may mean something different to the patient. Yep, it means being more thoughtful, which takes more effort and time. If necessary, add very brief explanation for the patient, it will save the patient worry and free up a bit more of the GPs time.

Saturday, 3 September 2016

Couple therapy

Many GPs find it a little unsettling when patients attend with their partner. However often there is significance to it. How best to greet them? I confess I attempt a little levity with most of my patients, since I generally know them well and have been around a long time. My favourites are...


1. Ah its Bonnie and Clyde.
2. And how are the happy couple?
3. Welcome to the dynamic duo.
4. Ah I see you've brought your bodyguard.
5. You'll be charged double on the way out.


All such comments of course are to be avoided if you do not know the couple or sense that the humour gene is lacking (in my experience fairly few patients, although perhaps they avoid me).

Greetings to be super cautious with are...

1. Ah..its little and large.
2. Ah..two fat ladies
3. Ah-oh this looks ominous
4. Not you two again....

But there is another side to this, why have they come together?

1. They may be expecting worrying news and want to be present together to hear it.
2. The non patient partner wants to make sure the patient tells the truth the whole truth and nothing but...
3. The non patient partner wears the trousers (in this case usually the female!!)
4. The adult male patient is a mummy's boy
5. The patient may be hard of hearing
6. The non patient may be super caring and devoted
7. They may want to gang up on you
8. They may want to sneak an extra opinion from you on the non patient.

And more and more. All to say that there is a lot going on in GP consultations which is why they are so endlessly fascinating.

Don't lose the shock!

I was talking to a patient this week who has worked in very senior positions in a number of companies. We were discussing how new employ...