As I come to the end of my six-month placement I reflect on my time in a general practice setting. I have seen many patients and have learnt something from each and every one of them.
1. It’s all about communication - and wearing multiple hats
The majority of our time as healthcare professionals is spent communicating, but in general practice I have found that the level of communication is amplified several times when compared with hospital medicine.
Being an excellent communicator is essential if you are to become a good general practitioner. Often, you are not only the doctor but you are the counsellor, mediator, social worker, dentist, confidante and more.
This can be demanding and sometimes by the end of a session I am emotionally exhausted.
Nonetheless, as doctors we are in highly privileged positions and we should use this to help as much as possible. Of course, not everyone is thankful and appreciative, but in my short career I genuinely believe that the majority of people we see as doctors do appreciate, respect and admire what we do.
2. Hidden agendas
When patients begin explaining why they have come in, both the GP and the patients have their own agendas. The GP wants to know the ‘what’, ‘why’, ‘where’ and ‘when’, but patients’ agendas can be more complex than you think.
Sometimes, patients present with an initial complaint, which is dealt with appropriately, but before leaving they will mention the main reason they have attended.
From our perspective as doctors this can be very frustrating, especially with time pressures in general practice. But it is important to remember that in some cases the patient has shown much courage in firstly coming to see their GP and secondly, informing the doctor of what is bothering them, even if it is during the last minute of a 10-minute consultation.
3. We are practising more defensively
Ever since I began my training there has always been a great emphasis on including the patient in management plans, understanding their wishes and beliefs and ultimately respecting patient autonomy.
There has been a shift (and rightly so) from the doctor simply diagnosing the patient and imposing a management plan with little inclusion of the patient’s views. But have we gone too far the other way?
Can doctors feel coerced or bullied into prescribing a particular medication or requesting an investigation? Perhaps because they do not want to receive a complaint?
Medicine, from my experience, has become extremely defensive; everyone is protecting themselves and documenting the minutia for medico-legal reasons. Of course record keeping is important for obvious reasons but I have seen, and am myself guilty of, documenting to the extremes.
While I do not agree with doctors taking complete control or sidelining patients with regards to decisions, I do think doctors are often used to giving patients what they want. The problem, of course, is that sometimes what patients want is not necessarily what they need or what is appropriate.
4. Reflection is paramount
Although reflection can take a considerable amount of time to do, it is extremely useful. It is helpful to look at a particular incident from different perspectives, to think about what you have learned and what could, if anything, be done differently in the future.
I also think it is great to keep a record of the interesting cases you have seen and managed during training so that you can remind yourself and use what you have learned in the future.
5. Managing the ‘angry patient’
Some patients have entered my room because they feel they should have been treated differently during the last consultation, or they are trying to manage an on-going problem that they feel is not being fixed or fixed quickly enough. Whatever it is, the ‘angry patient’ is angry for a reason and sometimes that reason is not always what they are telling (or shouting) at you.
I have often found that all they want is someone to show them some sympathy, empathy and to listen. I remember a case of a lady who came in and spoke for several minutes; I dared not interject for fear of being her new target. But, as soon as I said the word ‘sorry’ she immediately broke down into tears and told me why she was really upset.
That was the first time I realised how just showing someone you care, and that you are trying to understand their situation can change their mood and help them feel better.
- Dr Baptiste is a ST1 GP trainee in Romford, Essex
