The apprentice

Dr Laura Davison, a GP registrar from Milton Keynes, shares her thoughts on topical issues facing GP trainees. Here she explores how to break the ice in general practice

I read a troubling article in the newspaper recently. The UK is reportedly still lagging behind in global cancer survival rates because of the British attitude where people feel like a burden to their doctor, thus preventing early detection of cancer or increasing the loss of follow up.

As a trainee GP continually looking for ways to develop, I wondered how this attitude could be prevented by what I do during a consultation. I want my patients to feel valued not burdensome. Ok, I know what you’re thinking, and we all do it at times: “Why did they bother coming in with that?!” Well maybe that’s the question we need to start asking ourselves, and the patient.

Don’t be shy or British about this, ASK what they were worried about, and then take the opportunity to educate them for next time. This is not a waste of your time or theirs. Burden banished! It’s such a small and simple change to your practice.

"As a trainee GP continually looking for ways to develop, I wondered how this attitude could be prevented by what I do during a consultation"

As doctors we often forget the experience of visiting us can be a nerve-wracking one for many patients. Praying it’s nothing, but yet hoping it’s not a waste of time. The dismissive manner of some GPs can consolidate this belief. From observation, the highest patient satisfaction scores come when the GP appears to have a genuine interest in the patient and the comforting ability to make this anxious experience for patients a positive one.

There’s some truth behind the phrase “It was all very clinical” and pure focus on the medicine can leave patients feeling cold and uncared for. You can be Cambridge-Calgary perfect, but it’s the human experience the patient remembers, not the management you planned. The simple art of small talk, inquisitiveness and the use of comforting phrases that show you’re really listening, are key.

It takes nothing to ask about their job, or the family, or even make a simple comment on the weather to break the ice and provide a more positive experience. The aim is to relax a patient’s attitude and anxiety toward seeking medical help in the future.

"It takes nothing to ask about their job, or the family, or even make a simple comment on the weather to break the ice and provide a more positive experience"

The rote robotic phrase, used by the majority of clinicians for the traditional consultation sign off, is: “If it’s not better in six weeks, come back.” Patients don’t. They feel dismissed. The phrase is reeled off to everyone, whatever the complaint. Next time try: “I WANT to see you in six weeks, if it’s not better.”

It’s a simple change, but is a demonstration of personalising the consultation, shows interest in the person and lessens the anxieties of reattending. You want to see them. They are not a burden. Is this simplicity enough to improve the likelihood of patients attending the surgery for follow-up, or improving the chances of picking up a cancer earlier by reducing the British fear of burdensomeness? Surely it’s worth a try.