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Haslam's view: Ask who Thelma is on day one

I'm sure I can't be the only GP to have a patient like this.

He has been my patient for many years now. The problem is that most of the time I simply don't have a clue what he is talking about. He has the intriguing and infuriating habit of consulting me in a bizarre coded language that I have never quite understood.

For all my passionate belief in the vital importance of good doctor- patient communication, I have never quite managed to communicate to him that I really have no idea what he is on about. I clearly blew it years ago – instead of saying, ‘hang on, could you explain what you mean', I must have nodded at what he was saying and began to dig myself a deeper and deeper hole.

He typically gives me ten minutes of incomprehensible history, and then leaves expressing eternal gratitude and squeezes my hand for an age at the door. Clearly I am doing something valuable for him, even if I don't know what it is.

It's a strange job, being a GP isn't it?

One of the problems with staying with a practice for a long time, is that there are all too many patients who assume that you know everything about them, when in reality you either know remarkably little, or forgot it an age ago.

It's a great compliment to family doctors that we are often seen as close family friends, but obviously families typically only have one family to remember – and we have hundreds. I often have consultations that refer to some throwaway conversation we had years ago, sometimes about relatives that I don't know and problems I can't remember. I suppose I made the mistake years ago of nodding as if I understood the story, and can now no longer go back to square one without destroying any faith they had in me.

You can just imagine the response there would be to my saying: ‘I know you've been telling me about Thelma for many years, but could you please tell me who on earth Thelma is.'

Thank heavens for my new colleagues in the practice who can take detailed histories, record the facts, and at last allow me to make sense of the previously incomprehensible.

I guess the moral of the story is not to get into this mess in the first place – ask who Thelma is on day one, when you can be forgiven for not knowing, and write it down somewhere. But when surgeries are full and time is tight, it's not always that easy.

Sisters pose a particular challenge. Only last week I discovered that two delightful ladies who had been my patients for years, and whom I have probably seen at least ten times a year, are, in fact, sisters. Because their surnames are different I never had a clue. But they probably assumed that I, as their family doctor, actually did. Who knows what useful titbits of information I have missed over the years from my failure to put two and two together.

And I suppose it works both ways. Maybe my patients pretend they know what I'm talking about on occasions too, without actually understanding a word. Now there's a thought. It would certainly explain a lot.


Professor David Haslam CBE
GP, Ramsey, Cambridgeshire; President, Royal College of General Practitioners; national clinical adviser to the Healthcare Commission and Visiting Professor at de Montfort University, Leicester

Haslam's view

Maybe my patients pretend they know what I'm talking about on occasions too, without actually understanding a word

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