Uncertainty is 'key skill' for successful GP consultations, says NICE chair

GPs should embrace and accept uncertainty in patient consultations, according to NICE chairman Professor David Haslam.

Feeling and trusting uncertainty is an essential skill in general practice, Professor Haslam told delegates at the RCGP's annual conference in Liverpool on Thursday in a talk entitled The Uncertain Physician.

But he admitted uncertainty can be ‘massively unsettling and unnerving’ to GPs. ‘It was something I experienced the whole time in my 36/37 years as a GP,’ he added.

‘There was that constant sense of "what on earth was that about?" after every consultation.’

He said uncertainty can take many forms in a consultation – what the patient has come about, what the diagnosis is, when to refer or treat patients, and any legal ramifications of what the GP needs to do.

He urged GPs to remember the ICE model – thinking about what the ideas, concerns and expectations of the patient sitting in the consultation are – if they feel unsure in a consultation.

‘I found [the ICE model] invaluable. All too often, I would reach the end of a consultation and wonder "what an earth was that about?". And as my career went on, I realised it’s because I hadn’t thought about one of those three things.’

Uncertainty is also important because GPs have to understand and treat illness rather than just disease, he argued.

‘It means understanding the feelings of regret, fear, loneliness that turn the same disease into different illnesses in different people.’

He added: ‘There are two really important things you need to know about retirement. Firstly, the NHS will not thank you for your lifetime’s work and secondly – and much more importantly – your patients will.

‘Letters from patients will open your eyes. I was astonished to find almost every letter thanked me for almost same thing. It was a surprise, I didn’t even realise I was doing it.

‘They thanked me for being calm – when life was falling apart around us, they said, you were always calm.

‘Clearly, as we all know, there's something about a good consultation that is in its own way therapeutic, and that really matters - even if you feel like a swan (calm on the outside, but paddling frantically underneath the water).'

Full coverage of the RCGP annual conference 2017

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