Dr Liza Macdonald FRCR MA

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How to get the most out of a
consultation with your doctor

  Getting The Best out of Your Doctor

How to get the best out of your doctor: a list of 10 targets

1) Describing the problem

So what are you looking for when you go to see your doctor?
What is it that you want from him or her?
How will you manage to achieve that successfully?

Some people seem to find the experience both disappointing and frustrating.
The most frequent grumbles say something like..."He didn't seem to listen" or
"She was in a hurry" or
"She didn't look at me" or
"He wrote me a prescription but I didn't want it" or even
"I wanted a prescription for antibiotics but I wasn't given one".
So let's think about it.
Let's think about what we would really like from our doctor.
Let's then work out how we can achieve what we want. Let's also consider the doctor's point of view and see how you can best help them to help you.

2) What you want from your consultation with a doctor

If we could design a really good consultation what would that mean?

Think about these suggestions. There are plenty of them and just looking at the list shows you how complicated the consultation can be when you come to really think about it.[see box]

What do you want from this conversation?

To be recognised as an individual
To be listened to
To be carefully questioned on relevant details
To be professionally and appropriately examined
To have the examination noted in detail
To receive an explanation
To be given an opportunity to volunteer further information
To be asked your views
To make a shared plan for the future
To agree with whom information may and may not be shared

3) GP vs Hospital

Most of these suggestions apply first of all when talking to your GP. Hospital appointments can be a little different. The discussion usually concerns one specific diagnosis such as diabetes or heart disease. The clinic in which you are seen is mainly designed to follow this problem and the nursing and medical staff will have a particular interest in this condition. The discussion is therefore usually much more 'single track' and your hospital notes will record a running commentary of your progress.
Whether at the hospital or with your GP the same advice applies about talking to the doctor.

4) So what are you looking for?

First of all you want to be heard, you want to be listened to. You want to get the feeling that the doctor was paying attention...paying attention to you, focusing on you and concentrating.

You want to be recognised as an individual. You would prefer not to be thought of as a 'fifty year old woman' or a 'twenty year old man' or just labeled by your diagnosis... but as a person with your individual history, special concerns and personal needs.
And this is what the doctor wants to know too, who you are and what it is that you need.

If this is the first time you visit a practice the doctor will need a lot of background information: your past medical history, what medication you take and your social circumstances, are you working, do you have a family etc.

5) The start

When you come in the doctor will usually stand up, shake your hand and tell you their name and perhaps who they are... e.g. "I am a trainee or a partner here".

There will probably be a short exchange of relevant pleasantries such as....."Sorry to keep you waiting"....."How is the new baby?"....."Hope you were not caught in the rain"..... These kind of comments start the ball rolling, break the ice...establish you as a person. They start to create some rapport, some personal connection with the doctor...they establish a little bit about what you have in common as people. Both you and the doctor will feel much more at ease and able to discuss your problem.
Then you want to get quickly on to what brought you to see the doctor.

6) Explaining

It can take a little time to explain why you have come, but time is limited so it helps enormously to think this through before you go in. It needn't take long for most problems to be introduced and for you to describe how you are affected. You will want to explain the problem, how long you have had it and how it affects you.
For his part the doctor will want to know what the problem is. How long have you had it?
How does it make you feel? He will probably also ask if you have been abroad recently. Many problems previously only seen in a hot climate are now making an appearance in Britain. Problems such as tropical diarrhea, malaria, tuberculosis or parasites can be picked up on holiday. The doctor may need to consider these as well as more common causes for your symptoms.
When explaining yourself be brave and be clear. The doctor will have seen it all before. So don't be embarrassed or too ashamed to mention personal matters. The doctor will not be telling anyone else and needs to know the details.

What the doctor needs to know first

What is the problem?
How long has it been going on?
What are the symptoms?
How does it affect you?
Have you been abroad recently?

6) Next stage

When you have got the problem off your chest what do you want next?
You would probably like the doctor to question you in a relevant and focused way that shows that he or she was listening and has taken in what you said.
And you might like a little bit of sympathy too!...at least an expression of some fellow feeling such as "Oh that does sound painful" or "That must be quite upsetting".

The doctor will want to show they are interested and supportive...that he or she has some sympathy for your situation but not too much!
It's not much help if the doctor gets too involved and upset, and can't be objective and give you the benefit of their professional experience! That's not really going to help you deal with the problem.!
But it would be nice to know that they understand how you feel.

7) Doctor's questions

And now you want them to use their experience to put the problem in context...to ask you carefully about aspects of the problem that you may not have considered. When exactly do you get the pain? Is it related to food? Can you describe it further? Is it dull or sharp, burning or aching, worse when you take a deep breath? Or associated with exercise?
What can you do, if anything, to relieve it? What makes it worse?....for example.

As a general rule try not to volunteer straight away what you think is wrong. This kind of information can 'stifle' the discussion and lead the doctor up the wrong path. Allow a doctor to use their skills and experience and work it out for themselves. A good doctor will ask what you think is wrong but only after seeking the diagnosis for themselves.

After you have told the doctor about the main problem is there anything else?

8) Do you have a hidden agenda?

Just occasionally you may have decided that you want to sound the doctor out on a minor matter before you decide that you are prepared to discuss something that is actually more important. The wise doctor may pause at this point in the consultation and ask you if there is anything else you want to mention while you are here. That's a very useful question at this stage.

You may actually be really worried about something else but feel it is too distressing or embarrassing to mention straight out. If the doctor is sympathetic then it might be bean- spilling time! It might be time to explain why you really came.( that is if you do have another agenda...but mostly of course people are straightforward and do say what they mean...it's just nice to know the doctor is aware of the possibility of other issues)

From the doctor's point of view it is better to ask about other problems now rather than being taken by surprise as the patient turns the door handle on the way out and looks back with an unexpected question!
If that happens the doctor is in a real quandary. There is probably a waiting room full of impatient patients waiting for their turn. On the other hand the doctor may judge that this last issue is critical. What should they do? Ask you to sit down for a moment and explain or mention the queue and suggest that you make another appointment as soon as feasible? The circumstances will have to dictate how that is handled.

9) The doctor's notes

So when you are talking to a doctor what sort of information does he/she note down?
There is a lot of information which is relevant to you and your past and which may have importance in your current problem.
Doctors have developed a kind of shorthand....a series of bullet points and acronyms which are very useful. Here are some of them:

Information the doctor notes down

C/O : what you are mainly complaining of, the reason you came in.
HPC: history of the present condition
PH : past history including previous illness, childhood illnesses, operations, accidents
PGH & POH : past obstetric and gynaecological history including date of last period
FH: family history, what illnesses other members of your family especially your parents and perhaps grandparents have had.
SH: social history, what you do for a living, where you live, do you have a partner, who are they. (remember this consultation is protected by a promise of confidentiality)
TH: travel history, where you have been abroad recently? Tropical diseases are now quite common in the UK
Allergies especially to medication, plasters, rubber, xray contrast media as well as food allergies and asthma.
Current medication; what medicines you take regularly or frequently including "over the counter" drugs such as Neurofen or Aspirin

What comes next?

The physical examination...that's what. And this will form the basis of our next topic.

But just to complete this first visit let's wrap up the ending.

10) The end of the Consultation

So now the consultation is complete. You take your leave. What do you want to know as you go that will give you confidence that the problem is in hand?
What does the good doctor want to achieve so that the next stage of your medical care works well?

You want to leave the consultation knowing:

You were understood
There was up-to-date knowledge relevant to your situation
There was a clear working written diagnosis
You have a diagram if appropriate
There was guidance re self-help information
There had been consideration of your personal and family situation
There was a plan
Confidence that the plan will materialise
A return appointment/Follow-up arrangement
A phone number or email contact as appropriate
Instructions about re-contacting if arrangements fail.

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