Keeping control of the patient assembly line

'The Big Mo,' they call it in American elections; everyone wants it, Barrack Obama had it for a long time, but may be losing it, and political commentators say it's crucial for success.

It's the bandwagon mentality; everyone wants to be with the winning team and be enveloped in the loving embrace of gorgeous cheerleaders.

I know whereof they speak. A few columns ago I wrote about the importance of momentum in the waiting room; at all costs keep it moving, don't let them settle in their seats for too long, and then they'll come into the surgery with a clear understanding that that will also be a short sit.

That's strategy, what about tactics? First of all, don't waste time with banal greetings; it may give the impression you are looking forward to a long and cosy chat, that you prepared to metaphorically put on the kettle and throw another log on the fire and that time has no meaning to you. Before they are even halfway through the door, fire out the first question, and make it staccato.

Your movements should also be quick and sudden. If the phone rings, grab it immediately and bark out your responses. If the doomsday situation arises and clinical need demands, perish the thought, a physical examination, don't lose heart. Experienced patients will have played the game many times, and, having carefully prepared their stalling tactics beforehand, will have a vast succession of overshirts and undergarments to unfasten and undo.

This is a dangerous moment, the balance of power may be shifting, the whole surgery may be on the brink of disaster, and you have to be ready to seize back the initiative.

Every second wasted is a subliminal message to those outside in the waiting room; he's got plenty of time, is the impression they are getting, what's the rush? Let me tell you buddy, there is a rush, I'm a high-powered professional, my time is precious.

Leap out of your chair like a panther; while they are unbuttoning their shirt from the top, you can be unbuttoning from the bottom; while they are pulling their jersey over their heads, you can be unfastening their belts and yanking down their trousers.

Sure it's violent and aggressive and Dr Finlay would have had a fit, but isn't that what modern general practice is all about?

Dr Farrell is a GP from County Armagh. Email him at

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