Once a focussed history has been taken, examination performed and an explanation provided, it is vital that the patient understands what to expect, any red flags and the implications of thse red flag symptoms.
Describe symptoms
Explain to patients what symptoms they may experience based on your knowledge of the disease process. Patient information leaflets are very valuable in supporting your discussion.
Time frames
Some conditions may resolve within days but other pathologies may last years. Giving false expectation can lead to unnecessary re-consulting for the same problem and overall patient and doctor dissatisfaction. Providing a realistic time frame may prevent unnecessary consulting for similar future symptoms, thus empowering and educating patients.
Be open and honest
As primary care clinicians, we often see patients extremely early on in the illness process and a large proportion of symptoms will be medically unexplained following initial assessment. If you are not sure of the aetiology, explain this to the patient. This reduces the risk of false reassurance and most patients appreciate the honesty.
It is also important to understand what patients' thoughts and concerns are around their symptoms in order to avoid a mismatch of doctor and patient agenda.
Red flag symptoms
Most symptoms will have a set of associated red flags and clinicians must be aware of them in order to explain them to patients. Should patients notice any red flags, advise them to: call the practice during open hours; contact the out-of-hours service if the practice is closed; or attend A&E if it is felt to be life threatening.
Check that the patient has understood the information provided.
Follow up
Arranging follow up will depend on appointment availability and will be case specific. An acute problem or initiation of medication may require close follow up (two or three days).
A different type of consultation, for example PPI initiation, could be reviewed in one month, and certain problems can be left up to patients to re-present if the problem persists. It is helpful to specify duration in this instance.
- Dr Singh is a GP trainer in Wallsend, North Tyneside
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- This is an updated version of an article that was first published in 2010.
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