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Haslam's view: Building patient trust through chin wags

What's the most memorable request you have had from a patient?

Among all the demands for retrospective sick notes to cover cancelled holidays, pleas for certificates to allow golfers to use motorised carts rather than having to walk and the miscellaneous requests for an assortment of housing notes, one in particular sticks in my mind.

Some time ago, in the middle of a bitterly cold winter, one of my patients left a note for me at reception. The note read as follows: ‘Dr Haslam. My husband has lost his job. We don't have any money to pay the bills. The kids won't do anything I want them to do. We are all cold and hungry. Could I have a repeat prescription for some antidepressants so I don't worry about it so much?'

If anything summed up the inappropriateness of the medicalisation of life and its problems, it was that note. But the simple fact was that my patient knew of no one else to contact and nowhere else to turn for help.

Ever since I first became a GP, I have puzzled about cases like this – the patients whose problems are in no way medical, but who see us as the logical place to turn for help and advice.

Should we be proud or irritated by such consultations? Should our role be primarily medical (and, if so, how on earth do you define ‘medical'?), or is this social service a logical extension of our work as generalists? And how on earth do you code such an encounter? The other day I discovered there is a computer code, in my practice at least, for ‘Had a chin wag with patient' (code 8CB-1). It seems an extraordinary use of English and the oddest of options but it does seem to describe a lot of what I do.

The longer I've been in practice, the more tolerant I've become of such consultations. It seems to me that they are the price we pay for continuity of care and trust. If our patients trust us, and most patients do seem to trust their GP, we are likely to be the people who they turn to when the odd, the unexplained, or the upsetting happens in their lives. Why wouldn't they?

Indeed, I am quite certain that it is this personal, trusting relationship that keeps the NHS in existence. When you advise a patient who trusts you that a whole body MRI scan is not necessarily a good idea, it is this trust that protects the patient from unnecessary and potentially hazardous interventions, and protects the NHS from vast expense.

Take the trust out of the equation and the situation might be very different and no longer viable. And building trust probably means seeing many patients for things that we might not necessarily believe are medical business.

But it does make the issue of access something of a problem.

The great and noble initial intention of the GP service was to ensure that no one had to suffer pain or intolerable waits to access quality healthcare. But to guarantee that the service can be available for absolutely anything and everything, however tangential the issue, is problematic.

Maybe I'll contact my GP for a chin wag so we can talk about my concerns and anxieties. Or maybe not. Tricky, isn't it?

Haslam's view Author

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

The simple fact was that my patient knew of nowhere else to turn for help

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