Strategies for talking to health care professionals

In the past, general doctors’ practices were single handed, or had two or three like-minded doctors working as a group. These doctors were usually male, worked full-time, frequently made house calls, and knew their patients well.

The local doctor was respected and usually lived within the local community and their knowledge extended across generations because they knew their patients and their patients’ families for years. Emphasis was largely on diagnosis, treatment and reassurance, based on the practitioner’s previous observations and experiences, and patients seldom questioned the advice or treatment offered.

Modern family practice is now multidisciplinary, composed of a group of family doctors, physiotherapists, occupational therapists, counsellors and nurse specialists working from purpose-built premises such as health centres with greater gender balance. While General Practitioners (GPs) today have undergone many years of structured training, and are committed to lifelong learning, they may not know their patient’s family history, living situations or other key determinants of health. Many physicians may work part-time or live outside the local community.

Work practices and the sheer volume of business have resulted in time constraints, limiting normal consultation times to an average of ten minutes per patient. Continuity is not as dependent on building long-term relationships; instead, doctors rely on computerised records. Diagnosis and advice is now evidence-based and subject to protocols.

Emphasis has switched towards early intervention, accurate diagnosis, targeted screening and wellness programs, all leading to increased life expectancy and, most importantly, quality-adjusted life years.

For those of us who benefited from the previous system, we need to develop new strategies for negotiating the best result from a ten-minute consultation with someone we are less familiar with.

Before the consultation

• Consider seeking annual routine screening after the age of 65. This is useful to establish a baseline for routine blood tests, blood pressure and other vital signs while we are well. This can often be arranged through the practice nurse and may be combined with driving licence examinations, key milestones in your life (such as a birthday) or when receiving annual flu vaccinations.
• You may wish to be accompanied by a relative or friend, particularly if you are stressed over something. If so, negotiate their role prior to attendance: to listen and confirm what is said, to support you with their observations, as an advocate, or to assist with decision-making. Explain this person’s role and relationship to the GP so that it is clear to all.
• Prior to a GP consultation, list your main concern, secondary issues, and physical signs such as signs of disease that you can see, feel, hear or measure, such as swellings, temperatures, pulse rate, paleness, or skin changes. Symptoms are changes only you can describe such as pain, palpitations, nausea, and breathlessness on exertion. Also, describe any treatments you have tried beforehand. Try to restrict this to a few minutes, leaving more time for the cursory examination and detailed questions. If your medical record is more extensive, bring notes which the GP can review. Go suitably dressed and prepare to be examined, with access to appropriate areas, to save time.
• Arrive fifteen minutes early and check in as there may be a late cancellation. However, be prepared to wait patiently. Delayed appointments often signify a popular and empathetic practitioner, so bring a book.

During the consultation

• After brief introductions, be direct about what is bothering you.
• State your concerns, any secondary concerns, symptoms, signs and previous treatment. This allows the doctor to carry out a cursory examination, check pulse, blood pressure, heart sounds, or chest sounds, touch the abdomen and glands, or examine a specific area such as a joint.
• The remaining time can be devoted to more detailed questions about what the GP is observing in order to arrive at a differential diagnosis.
• At this stage, the GP will suggest a plan of action, offer reassurance, recommend a prescription, require more tests, refer you to a specialist, or provide the schedule for follow-up. Don’t hesitate in taking notes, so that you can refer to these later.
• If you don’t understand terms, ask so that they can they be explained in simple language.

After the consultation

• Check out with reception. Be clear about next steps and follow up procedures.
• Consider “debriefing“ with the friend or close relative who has accompanied you to ensure you are all on the same page and clear about the course of treatment.
• Consider writing an “aide memoire“ or create a health diary which you can bring with you to future appointments.

“Medicine is a science of uncertainty and an art of probability. A good physician treats the disease; the great physician treats the patient with the disease.”

• How has medical care changed for you over the years?
• What strategies do you use to improve your relationship with your doctor?
• What tips can you offer others for managing their health?

Glossary

General Practitioners: General Practitioners/family doctors are specialist physicians trained in the principles of the discipline. They are personal doctors, primarily responsible for the provision of comprehensive and continuing care to every individual seeking medical care irrespective of age, sex and illness. (From the Irish College of General Practitioners)