Under the eye of the clock

Man in restaurant (played by Sanjeev Bhaskar):  ' I think it’s really great that you’re a doctor. ' 
Woman, smiling:  ' Why? '
Man, standing up: ‘Cause I’ve got this nasty rash, innit?  (Woman leaves.)  Check please! ' 
 
Although a favourite of mine, this sketch is not all that true to life. In social settings, people are usually quite inhibited about mining the resource that a practising doctor is generally perceived to be.  They tend instead to ask polite, generic questions about some aspect of healthcare or its delivery, or avoid the subject of medicine altogether.

In the GP’s consulting room however, the atmosphere is often less restrained. For readily understandable reasons, the people I meet in daily surgeries often seem more intent on extracting the very maximum value-for-appointment than on goals such as achieving a sensible, shared management plan for the most pressing of their various health concerns, filling their (or their auntie’s) consultation to bursting with a succession of their symptoms or health-related issues, each of which requires at least five minutes of assessment and discussion to be properly addressed.
 
I am aware that I write this at the risk of starting my blogging career by portraying myself as the sort of GP who would rather spend his time on the golf course than listen to the concerns of those whose taxes keep him in Argyle socks.  Please believe me, gentle browser, when I say that the nearest thing to a sand-wedge that I ever see is wrapped in clear plastic and generally gulped down in the afternoon traffic on the way back to the surgery from a home visit. Nothing is closer to my heart professionally than delivering the kind of whole-person-centred primary care service that I would want for myself or my family.
 
In fact, I anticipate that a recurring theme of this blog will be the never-ending struggle to prioritise listening to patients,  this being the best way that I know of to empower people with regards to their health. But before I move on, in future instalments, to relate some of the scenarios experienced by those of us lucky enough to enjoy the position of community quack, please indulge me while I start by highlighting our most significant limitation as GPs.
 
The vast majority of GPs have just ten minutes per appointment, including the time required to document the details of each encounter. This is an aspect of British primary care culture that I hope will change before the end of my working life. For the time being it stands, however.  Into this time we attempt to squeeze in ongoing disease management and fulfil our various roles of diagnostician, confidante, confessor and fount-of-all-health-related-knowledge. Watch this space as your correspondent attempts to square this circle.
 
Hence, as most of the British public are doubtless aware, the GP who consistently runs his or her surgeries on time is  a rare beast; our clients come prepared to wait for quite some time and then get an extremely brief appointment. It's very tempting to compensate for the portion of your day that has just been so infuriatingly squandered in our waiting room by trying to squeeze in mention of every cough, ache and rash into a single appointment, but please resist as best you can. I will offer just two reasons for this. One is that over-rushed consultations are the least safe, in the sense that the doctor may be forced to cut significant corners in his or her attempts to avoid running further and further behind.
 
And the second? The second is that it winds us up something awful. I am reliably informed that many patients present their symptoms and queries with enormous care to avoid being judged or type-cast by their doctor as neurotic, unintelligent or worse. But the most reliable way to make us judge and resent you is to sit down and say 'I don’t come very often so I’ve saved up a list of things to ask you', and expect us to respond with appreciation.
 
Meanwhile, our surgery tries to avoid similarly winding up its patients.  The sign 'only two issues per appointment please' has been debated, but still does not adorn our walls.  The system we have in Britain does sometimes impose a strangely staggered interaction  -  spreading half an hour's dialogue over the space of  weeks - even though this can on occasions be significantly detrimental to the patient.