The Write Action
Photo by Hugo Jehanne on Unsplash - Oeschinen Lake, Kandersteg, Switzerland
First published in Consumers Health Forum of Australia’s newsletter May 2019
A recent study in 2018 by the Australian Bureau of Statistics (ABS) revealed that people with three or more long-term health conditions felt less socially supported compared to people without.
As cited in this newsGP article, the average person attends their GP on average six times a year, and a specialist once a year. It is therefore evident that health literacy and quality of healthcare has never been so important.
Having worked as a GP for 16 years, and living with my own health issues, I can see the health system from both sides. Over the years, I’ve shared the journey of thousands of patients and advocated on their behalf countless times.
In this article, I’d like to offer some practical suggestions for the health consumer in order to get the very best out of your GP.
Booking your appointment
The receptionist is the gatekeeper to your GP. Often GPs will allow long appointments to be booked for certain issues (like mental health and women’s health) or if it is for multiple issues. Without pre-planning, it is not always possible for the GP to just extend the consultation if they have others waiting to be seen. Don’t worry if your GP recommends that you return for a further appointment if the condition is complex, as some things can’t be dealt with in the standard 15-minute slot.
If it is the first time you will see Dr X, it will take some time for them to get to know your past medical history so they can put your current issues into context. It can save time to bring in a health summary from your last GP, or to write one of your own beforehand. List any serious medical problems and hospital admissions, operations, medications and allergies, and family history.
What you want from your consultation may be different from your GP. Unless they know you well and you have a good mutual understanding, there is a risk that you will leave the room dissatisfied. If you can, clarify your needs beforehand (including thoughts, concerns and any expectations) about your health. If you have more than one problem, tell your GP at the beginning so that you can both prioritise and set aside the appropriate amount of time. Rushing through a list just to get them ticked off in one go is not good news in the long run.
Photo by Alice Lam @AliceLamWriter
On the record
Writing things down before and during the consultation can be beneficial if you’d like to have a record for later. Sometimes I provide a typed or written summary of major ‘take home’ points for my patients, especially if a lot has been covered in a session. I started doing this after a few occasions when patients returned, having completely forgotten points discussed, or to carry out certain agreed actions from the last consultation!
Is your GP listening?
GPs are trained to listen first, and speak later. Unfortunately, not all GPs abide by that saying. A study in the USA found that many patients will have stated their agenda by about six seconds, though some took as long as almost two minutes. Doctors only elicited a health consumer’s agenda half the time (contrasting with specialists who lagged behind, only getting the patient’s agenda one-fifth of the time).
So, that first minute or more when you start talking is golden and should be uninterrupted. It’s that precious time when you bring up your agenda in your own time and style. Many GPs, myself included, have been tempted at times to start bombarding the patient with questions, thinking we already have the answers.
If you don’t feel you’ve had a chance to say everything you need (within reason), ask your GP to let you finish. It is well known that not listening adequately to a health consumer leads to problems, such as missing particular details and as a result, doing the wrong examination, or ordering the wrong tests for instance. In the worst case scenario, you could get the wrong diagnosis and treatment.
What is your GP thinking?
Doctors may share similar training yet we develop our own methods of diagnosing and treating our patients. One GP might like to get a good understanding of all your past medical issues, family history, smoking and alcohol status etc. before moving on to your current problem. Having this knowledge at the start can often make a difference to the outcome.
An example: 30-year-old ‘Jenny’ comes in with a breast lump. She might receive a more conservative approach such as surveillance before having a scan further down the line, but if her family history is of cancers that increase her risk then management should, of course, be fast-tracked.
On the other hand, another GP may prefer to deal with a current issue and get to the less ‘urgent’ items on another occasion. That might make a health consumer feel happy that something has been done but may miss addressing items that could affect long term health.
An example: 50-year-old Joe comes in with a sore knee. It looks like arthritis and he is sent home with advice on painkillers and exercise. He feels better so he doesn’t return. But he hasn’t been asked about his father and uncle dying of heart disease in their 40s, so this might be a missed opportunity for screening
Do I need an examination?
Many patients feel embarrassed or apprehensive about having certain intimate examinations. That is quite understandable, and even doctors can feel the same way when they see another doctor. GPs are used to patients getting nervous, and if made aware beforehand, they can gently explain about the procedure and take it at the patient’s pace.
Personality and communication
These are aspects which have a significant impact on how your consultation will go. Is your GP rigid or flexible? Are they paternalistic, as in “Do as I say” or more about you – “What would you like to do?” It depends on your personality as to whether you’ll be able to work together towards your health goals.
Does your GP explain difficult terms, and answer your questions to your satisfaction? Are they patient with you? Do they encourage you to take on responsibility and autonomy in your health management, where possible?
Something that is not talked about much, is when GPs (and other doctors) talk within earshot of receptionists, other doctors, and worse still, other patients. Your GP should never discuss your health with anyone else without your permission. A good doctor never forgets about confidentiality and the circumstances where this trust can be broken are extremely rare.
Continuity of care
Ideally, you will have just one GP who works full time. This means they will know you and your issues and be able to manage you better than someone who only sees you occasionally. However, given that many GPs work part-time, and in any case all will take time off at some point, try to stick to a maximum of two GPs in the same practice. Not only will they be able to share your health record, they will be able to talk to each other to have more of a team approach to your care.
Getting a second opinion
When might you consider seeing a second GP? There can be times when your regular GP seems to have hit a roadblock with managing your health, or you just don’t gel for reasons of personality or communication style, for example.
If that happens, you have a right to seek a second opinion, either within the same practice or in a different clinic – the latter being a benefit of the Australian health system not available in countries like the UK. A fresh pair of eyes and a new perspective can make a big difference if progress has stalled. Some people feel guilty if they move to another doctor, which is understandable, but unfounded.
Asking for assistance
Apart from medical advice and treatment, what about navigating the health system? Only about a quarter of people surveyed by the ABS found it easy to navigate the health system, with increasing difficulty for people experiencing psychological distress. People may need help with booking an appointment for an outpatient clinic or an investigation, understanding a treatment plan, or working out the best options available. Again, ask your GP, receptionist or practice nurse if you need help.
Image by aj-garcia-454112-unsplash
Mental health issues
The Australian Institute of Health and Welfare (AIHW) found that during the period 2015-16, the number of people attending with mental health conditions was on the rise; a third of were attending with depression. And with an estimated four million Australians experiencing a common mental health condition in 2015, these statistics show how serious mental health care is.
There are many facets to a successful mental health consultation, and to go through them all would be outside the scope of this article.
In brief however, I would recommend that a long appointment be booked in advance, and if possible, that a partner/friend/relative accompanies you. In my experience, that gives the person emotional support, as well as the support person being able to ensure that their needs are met. In addition, more objective information can be provided this way, as often someone with mental health issues are too distressed or lacking in full insight to give a full explanation of their symptoms.
I’d also suggest keeping a daily journal, however brief. Even if it’s just a score out of ten for mood and sleep plus a sentence or two, it can be invaluable for dealing with the issues at hand.
Your health is of the utmost importance, and should be top priority for your doctor as well.
Look for a doctor with good communication skills, empathy and a collaborative approach that empowers you.
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Dr Alice Lam
I'm a doctor who is passionate about writing quality health content.