How should the consultation end satisfactorily?

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Once there is a working diagnosis make sure that you agree a plan of action.

Ensure that you understand what should happen next… perhaps you will be referred for a specialist opinion, perhaps there will be a test arranged such as a blood sample or an x-ray. Check when these will happen, what sort of request form will be needed.

Check how to contact the department who will undertake the test.

If you are to be referred to a specialist at a hospital discuss which hospital the GP suggests. Most patients now have the right to choose which hospital provider they are referred to by their GP. This legal right, which was introduced in April 2009, lets patients choose from any hospital provider in England offering a suitable treatment that meets NHS standards. In practice most people usually choose the nearest hospital, but you may do better to consider other factors such as reputation, clinical performance, parking facilities or other patients’ experience. The Covid epidemic has of course made all this more difficult.

Once there is an agreed plan of action thank the doctor and leave promptly.

Go to the reception or to the doctor’s secretary and report what has been decided.

Show them the forms or the prescription and make the appropriate follow-up appointment.

Check how you will get the result. (See How to get your results)

Most GPs have a large sign in the waiting room telling patients to confine their conversation during the consultation to a single topic. Government guidelines have recently been prioritising choice and access to ensure that all patients have the opportunity to speak to a doctor. (This policy has not always been successful!) The result is that consultation slots are short and turnover rapid.

How should you cope with this if you have more than one problem?

You might mention to the doctor briefly at the outset that you have two problems. Unknown to you these may in fact be connected. Some diseases are multifaceted and the problems you see as separate might in fact be part of a whole e.g. a specific skin rash and a type of arthritis.

If one problem is more important than the other start with that. If time allows deal with both. Otherwise, you may simply have to make a separate appointment to bring up the second issue. Most receptionists, due to the pressure on doctors’ time will be unwilling to book a double appointment to deal with two problems…. but you can try!

What does the good well-informed doctor seek to provide in this consultation?

There are of course two participants in any medical consultation. The doctor is a person too with hopes, ambitions, expectations, frustrations, and human frailty. Although the medical profession has often had a bad press there are very many doctors who sincerely seek the welfare of their patients. They studied medicine because they wanted to improve the world to “make things better”. Medical education is a lengthy and strenuous training, and it takes real grit and determination as well as a reasonable level of intelligence and physical stamina to get through all those exams. So, when you enter the consulting room you have before you, more likely than not, a motivated professional person whose main aim in the next ten minutes of consultation (or half an hour depending on the situation) is to find out what health issue has brought you to the clinic and how their expertise can at least start to sort it out.

The doctor’s intention is really the mirror image of yours. To start with a doctor wants to establish a rapport with you. He or she wants to get to know a little about you and engage with you on a personal level. Next, he or she wants to make it easier for you to explain why you have come which usually means using an open question, such as “Well tell me what brought you in today?” “How can I help you today?”. They will want you to explain the problem and how you are affected and then elicit relevant further information in a timely manner. They will be pressed for time but will instinctively absorb much more than your words as you explain the problem. They will note your body language, your tone of voice, your pace of speech, underlying mood, your degree of anxiety and the severity of your symptom(s).

At the back of their mind, they will be aware that what you are describing may not be your only problem and will give you an opportunity to raise a further issue. They will want to cover all the relevant background information which may have a bearing on the problem. They will want to examine you in a way which demonstrates respect and preserves both your dignity and your privacy. They will want to combine the verbal information and the findings of their examination to achieve a working diagnosis or a differential diagnosis i.e. alternative explanations for your problem. The doctor will then want to explain the working diagnosis in an understandable, effective way and to find out what you think about it. She or he will want to create a viable, working partnership with you and consider involving family members as appropriate. They will establish and maintain confidentiality. They will then move on to arrange appropriate investigations if these are necessary and to communicate with colleagues as the situation dictates. They may need to give instructions to the nursing staff, they may need to consult a colleague, they may need to refer you to a specialist. Finally, they will need to make a fail-safe follow-up or contact arrangement and an opportunity to reassess or reconsider the problem. They will hope to both gain and maintain your trust.
Importantly, they will continue to remain under the duress of time limitation and must manage this effectively.

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