A registrar survival guide - Consulting with the 'worried well'

Consulting with the 'worried well' can be very challenging. The number of worried well patients will vary between practices but you will come across these patients from time to time.

The challenge is recognising significant pathology amongst the symptoms presented in the time constraints facing modern day general practice. It is important to understand the basis for the patient's worries, and good communication skills are required to do this.

Ensure that the patient is well

The patient may well have a symptom suggestive of significant pathology that requires full investigation. Ensure you are happy that you have ruled out any medical causes.

Remain calm

Remain calm when reviewing this group of patients. You may find that all you need to do is listen. A good display of empathy will help potentially resolve anxieties and enhance you relationship, which in turns helps deal with future anxieties through trust and a strong doctor patient relationship.

Explore the patient's health beliefs

Careful exploration of the patient's ideas will allow you to establish what they think could be causing their symptoms. You can use these ideas to get a better understanding of their health beliefs. This will help you when explaining why you think their beliefs are not true, if indeed this is the case.

Identify the cause of anxiety

Identifying what the patient is truly concerned about will allow you to understand what is likely to be driving their anxiety. Picking up on verbal and non verbal cues will help identify levels of patients anxiety during the consultation. This can then be further explored and managed appropriately.

Find out the patient's expectations

Finding out what the patient expects of you as the professional can allow you to meet that expectation or, alternatively, reach a compromise if you feel that course of action is not necessary or inappropriate. This can be done in several ways but is important you establish this in the first half of you consultation to allow you to formulate your management plan around this.

Transfer of care

It may be necessary to acknowledge that you can no longer help a particular patient. At this point, a discussion with a colleague about transfer of care may be appropriate whether that be to another GP colleague within your surgery or another practice.

You may have to act as the patients advocate and if they request a second opinion from secondary care, then you may have to authorise this depending on the situation.

Essentials checklist
  • Confidence and commitment in your clinical judgment.
  • The patience to explore the patient's ideas, concerns and expectations.
  • A calm, listening approach.
  • Dr Pipin Singh is a GP in Northumberland

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