Thursday, 10 August 2017

It's only words

I recall whilst a medical student being encouraged to clarify the meaning of words when taking a history from a patient. So when the patient says they have diarrhoea, what symptom are they describing? Is it very loose stools, is it going more frequently, is it one loose stool per day, or six times? In other words it needs clarifying.

I'm working for the first time in Scotland as a locum in Lochilphead 'just now', a lovely part of Argyll. And so when I ask an elderly lady how long the pain in her calves has troubled her, she confidently says, 'a wee while', and when I ask how far she can walk  before the pain starts she tells me, 'only a wee way'.  Concerned that she may have peripheral vascular disease I ask if she smokes. 'Oh yes of  course, but I gave up ' she says. 'And how long was that for'? I ask, fearing the worst....'Oh a wee while ago'.

Communication is at the heart of General practice and helping patients tell their story is a crucial skill. It may seem laborious at times, but it's essential to gently and persistently seek to understand what the patient actually means by what they say. Otherwise mistakes can so easily be made.

More and more health care is delivered by phone or even online. I'm sure some of that is helpful and appropriate, but without the to and fro of a normal, face to face conversation we may get the wrong end of the stick, leading to misunderstanding. So just speaking to patients on the phone should  be approached with a degree of caution, since we can also miss those non verbal cues which can fill out what the patient is trying to say to us (let alone the added benefits of examination). With increasing telephone triage in the NHS as it seeks to cope with increasing demand, we need to be alert to the risks.
Tarbert harbour near Lochgilphead 
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