Following on from my recent blogs “10 Insider tips I bet you don’t know about your GP” and “Everything you know about going to the doctor is wrong”, I thought it was time to give you some pointers about how to ensure you get what you want out of your GP appointment. We have probably all felt frustration in struggling to make an appointment, taking time out of a busy day and waiting to be seen only to then feel that what we were after has not been provided. How can you change this? Here are my tips:
Make sure what you want is what you need.
To quote The Rolling Stones “You can’t always get want you want…”. This is the most fundamental tip you need to understand. You need to consciously think about what you want from your doctor and whether this is actually what you need. The two things are not necessarily the same. Sometimes this is about taking a step back in your thinking. You may have gone to the GP wanting a referral to a specialist, but what you actually need is your problem addressing – this is going to bring you into conflict with your GP if she (or he) feels they can sort your problem without a referral. Maybe you have gone to the GP looking for antibiotics for your cough? As I have said in my earlier blogs, what you really need is someone to properly assess you and make an expert decision about whether you need treatment, further investigation or just a bit more time for things to settle. If you go to the doctor with the intent of seeking their opinion and view on your condition – this is easy to get your GP to do.
Be crystal clear about what you want.
If you do not explain, clearly, to your doctor what you are after, don’t be surprised if you walk out without your needs being met. As I have said before, your Doctor is not telepathic! I strongly suggest, however, that you remember the first point here, and try to keep an open mind about what you want, and be prepared to listen to what your GP has to say. Let’s try to have grown-up adult conversations with our doctors about what is concerning us, what is important to us, and what we are hoping for. This is a much better place to start than with a demand or with unrealistic expectations.
Probably the most important thing you can do to get your doctor to do what you want is to ensure they understand where you are coming from, what your concerns are, what you have already learned about the problem and what is important to you. Fundamentally your doctor wants what is best for you, but a large part of that is for your doctor to understand what you feel the best thing for you is. Patient Centered Care is what this is all about. Your doctor doesn’t want to do things to you that you don’t want.
The flip side to this is that your doctor does not want to do things to you that they think will not help you, or may harm you. If you find yourself in a situation where you are asking for an intervention and your doctor is reluctant, this needs exploring. I would urge against digging your heels in, insisting on action, and complaining when you don’t get it. The far better initial response is to fully understand why the doctor is concerned, and to let them know where you are coming from. This might not resolve things, but at least improves understanding on both sides (and let’s face it, if we are talking about ‘sides’ then things have already gone wrong – your doctor would always like to be on your side…). Try to aim for co-production of plans.
Understand what your GP is able, and not able, to do.
As with anything in life, if you are asking the wrong person, you are not going to get what you want. This is an area of difficulty with GPs as their remit is so broad it can be hard to know where their responsibility ends. In simple terms GPs provide primary care services for patients who are or believe themselves to be ill or suffering from chronic disease. This includes health advice, referral to other services and, if requested, immediately necessary treatment due to an accident or emergency within the practice area. (This is a paraphrase from para 8.1.2 from the GMS contract and thanks to a social media contact for signposting me to this). It is sometimes easier to describe which services they are NOT paid to provide for you, as this can cause misunderstanding. They are not obliged to provide a home visit just because you don’t have a car. They are not obliged to provide a fit note during the first week of an illness, as you can ‘self-certify’. You can use the form found here: https://www.gov.uk/government/publications/statutory-sick-pay-employees-statement-of-sickness-sc2. They are not obliged to write you a letter for anyone explaining how your medical condition affects your housing/horse-riding/ability to attend lectures/ability to sit your exams/ability to wear a seat-belt etc.* They are not obliged to complete medical insurance forms*.
*There are a number of private services that GP will usually provide, and these letters and reports fall into that category. Your GP will charge you for these services. For some of them, your GP will need to make a decision about whether they can complete the form or not. If, for example, you are asking your GP to sign a form to say that you are fit to run in the Paris Marathon, then they may not feel they have the expertise to make such an assessment – there are alternative providers that you can find on-line who can do this for you.
The thrust of this tip is to make sure you understand that your doctor is unable to provide everything that you might like them to. Try not to go in with a demand, but a query, and try to have found out in advance if they are really the right and/or only person that can do this for you.
Remember that your GP provides a different service to your consultant.
This means that your GP is not usually the person to ask to get things done at the hospital. If you have been to a consultant and they have arranged tests that you want the results of – I would suggest you ring the hospital. Whoever arranges a test is the person who will receive the results. Please do not assume that your GP will have the results, and even if they do please don’t assume they are the best person to relay those results to you. Specialists tend to arrange specialist tests. Your GP may not know how to interpret the results, and may not know what the consultant plans to do next.
People commonly attend the GP wanting things sorted out with their hospital appointments. Why not ring the hospital directly? If you don’t have a direct dial number, just ring the main hospital number and ask to be put through to your consultant’s secretary, or if it is about your appointment, then ask for the appointments department. Cut out the middle-man (the GP) and go direct to the person who can help you.
We have just scratched the surface here in terms of the number of reasons that might be behind your frustration that your doctor is not doing what you want. The key message from me is for you to understand that your doctor does really want what is best for you, and for you to understand that they might not actually be the person to be asking. Sometimes it is about thinking more closely about what you feel you need, sometimes it is about finding the right person to help.
At the end of the day, being clear and seeking to understand is fundamental. I hope these tips will help you to do just that.
Dr Jonathan is a GP at Swanlow Surgery in Winsford, Cheshire, and Chair of NHS Vale Royal Clinical Commissioning Group
If you have any questions for Jonathan why don’t you find him on Twitter @DrJonGriffiths