You’ve been going to the doctor all your life. You know how this works, right? Wrong. In my last blog I gave you “10 insider tips I bet you don’t know about your GP” (https://drjongriffiths.wordpress.com/2018/01/30/10-insider-tips-i-bet-you-dont-know-about-your-gp/), and now I’m going to tell you how you need to change your approach to going to the GP, and why. Do you think your GP’s primary aim is to ‘get you better’? Do you wait for your doctor to ask all the right questions during the consultation? Do you feel cheated if you don’t walk out without a prescription? If so, you’d best read on…
Your doctor is probably looking to assess rather than looking to treat
This is really important to understand, and often where things can get off to the wrong foot in a consultation. What is your approach to going to the GP? If you have a bad cough or sore throat, what are you looking for from your GP? If the answer is that you go in order to be ‘made well’, then I would suggest you change that approach. Your doctor knows that the majority of acute illnesses get better themselves. Coughs, colds, sore throats, earache, tummy ache, vomiting, diarrhoea, rashes etc all tend to be ‘self-limiting’. When your doctor sees you she (or he) is not thinking “What do I need to prescribe to sort this out?”, they are instead thinking “Do I need to treat this?”
There is a fundamental difference in the two approaches. One has the expectation of a treatment; the other has the expectation of a professional opinion. If you go expecting the former, you are setting yourself up for disappointment, and potentially confrontation when your doctor has other ideas.
My tip: Go to your GP for their expert opinion, not necessarily for them to make you well.
Your doctor will learn more from the story you give than the examination they perform
People often go to the GP in order to be examined in order to work out what is going on. It’s important to realise that the history is much more important than the examination (doctors use the word ‘history’ to mean the story that you give – i.e. your description of the symptoms you have). This means that getting your story straight is really important.
When you first sit down in the GPs office, they are likely to start things off with an ‘opening gambit’ – an open question inviting you to say why you have come. Each doctor will likely have come up with something that they are comfortable with such as “What can I do for you today?”, “How can I help you?” or “What seems to be the problem?” Regardless of what they say, this is your opportunity to explain why you are there. Be as detailed and specific as you can. Don’t just say “I have a sore throat” and wait for more questions. Instead try “I started with a runny nose 4 days ago, then when I woke up the next day I had a bad throat. It has got worse rather than better and I’ve been taking paracetamol at maximum dose for the past 3 days. I am not eating anything as it’s too sore, and I’m not drinking much either.” You see the difference? A good doctor will follow up with another open question, such as “Is there anything else?” which will allow you to provide even more detail not just about your symptoms but also about your thoughts, ideas and concerns. Adding “I had tonsillitis a couple of years ago and this feels just like that, I wondered if I had it again?” is helpful as it lets the doctor know where you are coming from.
Be clear about how long things have been going on for. You would be surprised how often people say things like “I’ve had this cough for ages”, or “It’s been like this for a long time”. Don’t leave your doctor guessing – if they have to resort to asking “Has been days, weeks, months or years?” then you have probably been too vague!
Get as much out as you can in that first minute or so, fully explaining your symptoms as well as your own ideas or concerns about what’s going on.
In addition, be upfront about any “list” of problems you might have that you want dealing with. If you read my previous blog you will remember that I said “Your doctor does not like lists”. I think this is largely true, although a list declared at the outset that can be tackled together with your GP is not always a bad thing – just be aware of how much time you might have (usually no more than 10 mins to include time walking to the room and the computer entry).
My tip: Tell as much of your story as you possibly can in the first two minutes of your consultation.
Your doctor really wants to know why you are there
It might be obvious to you, but may not be obvious to them. Take the previous sore throat scenario. If you don’t tell them upfront then your GP is left guessing. It could be for any of the following reasons or a multitude of others:
- You want antibiotics
- You want to rule out tonsillitis
- You are worried you might have glandular fever
- You are worried you might have throat cancer
- You want a sick note
I hope you can see that the doctor will manage a consultation looking to reassure about throat cancer very differently to one where you are not looking for anything other than a note for work. It does help your doctor if they know what your motivations are. Don’t be offended if your GP says “Why have you come?” It’s really hard to frame the question without them suggesting you didn’t need to be there (which is not the intent behind the question!). Above all – don’t treat this as a ‘test’ for your doctor to see if they are good enough to work things out for you – surely you want a partnership with them in order to get the best outcome – for you!
My tip: Be very clear why you have attended to see the doctor, and do that at the start of the consultation.
Your doctor may not be able to say what is wrong with you
And that does not mean that they are not a good doctor! Your doctor will be hoping to make a definitive diagnosis, but more often than not they will instead be looking to make a list of ‘differential diagnoses’. This is a list of conditions which all share similar symptoms. On that list there will be conditions that your doctor will wish to actively rule out, and if they can’t, they may wish to investigate further. Sometimes they can do this within your consultation. Sometimes they will need to arrange further tests. Sometimes they will want to see you again to see if things have settled. Sometimes they will send you away with instructions about what to watch out for to prompt a return visit. Which approach is appropriate depends upon your history and the examination findings. Do not be surprised or disappointed if your doctor cannot tell you, for certain, what is wrong with you. It is more likely that they can tell you what you don’t have. This is a key part of what GPs do – try rule out important, serious, life-threatening conditions. Whatever is left may not need treating, or even diagnosing!
Very often your GP will use time as a tool to aid diagnosis. This might mean that you don’t get a definite diagnosis on your first visit, but when you come back (not better), then this will trigger further tests. This does not mean that you should have had the tests the first visit. Don’t be fooled by the ‘better safe than sorry’ mentality – having too many tests is also bad for your health, resulting in, potentially, side effects from the tests and/or ‘over diagnosis’.
My tip: Don’t worry if your GP can’t tell you what is wrong first time!
Your Doctor is not just a gatekeeper for a prescription
It is not all about the drugs. Remember the first tip. What you really want is an opinion, maybe a diagnosis, and only treatment if you need it. Sometimes when people go to their GP they feel that it was a waste of time if they don’t come away with a prescription. NOT TRUE! The assessment and evaluation and opinion that a medication is not needed at this point in time is of great value.
Here’s another thing. Why would you want to take a drug that you didn’t actually need? Do not be fooled by the better safe than sorry mentality. There is risk associated with every course of action. Taking prescription medication comes with a risk (that’s why you need a prescription, you need someone qualified to decide if you need it, someone qualified to decide if the potential benefits outweigh the potential risks. The risks vary from drug to drug, but for commonly prescribed antibiotics they include side effects such as diarrhoea, allergic reactions, thrush, rashes and interactions with other medications. There is also the risk of increasing antibiotic resistance that comes with increased antibiotic prescribing, and, of course, the financial cost to the NHS of the prescription.
My tip: Don’t be rushing to take prescription drugs.
I hope you can now see that there is more to general practice medicine than meets the eye. Understanding how your GP is approaching their consultation with you can help you adjust your approach with them. Being on the same page as your GP can only help this process and get you the help you need when you need it.
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If you want to ask Dr Jonathan anything, then find him on Twitter @DrJonGriffiths
Dr Jonathan is a GP at Swanlow Surgery in Winsford, Cheshire, and Chair of NHS Vale Royal Clinical Commissioning Group.
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