‘What would you do, doctor?’
Writing competition finalist Dr Richard Cook wonders how to avoid the patients who ask him to make their decisions for them
We recently interviewed candidates for a new GP partner and a lead nurse to replace team members who are retiring. We thought long and hard about what to ask to bring out the best in the candidates, and the questions must have been alright, because we are happy with the people we chose to replace our old colleagues.
I was keen to ask candidates to describe their consulting style in three words (I was hoping for someone to be brave enough to answer simply, ‘succinct’). In the end this question did not feature, but if someone had asked me, I would have said ‘minimalist’. As per conversations with my wife, I have learnt to say little, listen carefully, nod and grunt at appropriate times and leave the door open for further discussion if needed.
I feel comfortable in this style, but it is perhaps more a reflection of my persona than any learned technique. Some of the more verbose partners consult differently, and it is nice to have such variety in the practice. After all, patients always ask for the doctor who seems to understand them best.
But occasionally I get shaken out of my comfort zone, namely when the tables are turned and the patient starts asking me questions. ‘Hang on a minute,’ I think, ‘I’m Jeremy Paxman here, not you.’
I was recently stumped by a patient I was counselling about a vasectomy, when he suddenly asked me, ‘Have you had one, doc?’
Where do you start when answering that? A straight yes or no would be perhaps the easiest way, but the implications of the enquiry go much further.
What might they ask next? ‘I’m struggling with the fall-out of an affair. Have you ever had one, doc?’ This type of questioning almost takes the conversation out of the consulting room and into the pub: a few mates sitting around having a drink and picking over marital difficulties. That’s not where I see myself when I am consulting, but maybe an informal tone is an indication of that your patient feels confident asking for your advice. There are no set boundaries for the patients in the consulting room of course, just social convention, and we can learn a lot about patients from the questions they ask.
The obvious Catch-22 for any GP is being asked, ‘What would you do, doctor?’ – an almost impossible question to answer. I could try to separate my own learned experiences and medical knowledge from the patient’s. But despite having a broad overview of the evidence behind medical treatments, it is difficult not to let my own observations affect the decision-making process, and answer the question with reference to patient’s circumstances rather than my own.
Would I take medication to turn my yellow toenails clear again? No – not after I have seen one nasty medication-induced hepatitis, but then again I’m not a 19-year-old foot model looking for work.
Similar to my manner as a doctor, as a patient I tend to be a minimalist. I am inclined to do little for my health problems, take few treatments and rely heavily on nature taking its course, particularly in acute illness. In reality, some patients take a different view on life, and in the consultation I try and present the pros and cons of treatment (or not) as best I can.
The really tricky advice is when the benefits of treatment are not clear cut – palliative chemotherapy, for example. What would I do? I really don’t know, and as there are so many differences in our situations, I also don’t know what you (the patient) should do – but we will sit down and work through it together.
So what should I do the next time a patient says, ‘Can I ask you a question?’ Run for cover?
If they ask me, ‘What would you do, doc?’, I will give them the best answer I can think of:
‘I would ask my doctor’.
Dr Richard Cook is a GP in Hurstpierpoint , Sussex.
Pulse asked for talented GP writers to send us stories to inspire and amuse their colleagues, and we were bowled over by the quality of the entries submitted.
Nearly 30 GPs took the time to put pen to paper – or finger to keyboard – and entries varied from amusing tales from consultations to clinical dilemmas or political ideas about general practice or the NHS in general.