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Independents' Day

CCGs tell patients to question their GPs

A CCG has created a ‘cue card’ with five questions that patients should ask their GPs in consultations, including whether they may have been misdiagnosed.

NHS West Leicestershire CCG has said patients should ask whether their diagnosis could be something else, what the treatment options are and what are the pros and cons of the treatment options.

It titled the postcard-sized cue cards ‘MAGIC’, which stands for ‘Making All Good (decisions) In Collaboration’, encouraging patients to ask more questions of GPs, consultants and other healthcare professionals.

The CCG said that the aim of the cue cards, which will be available in all 50 GP practices in the area as well as being handed out by Healthwatch, is for patients to have the information they need to ‘take more control over the choices involved in their healthcare’, with the cards to ‘help start the conversation’.

The five questions on the MAGIC cards are:

  1. What is my diagnosis – could it be something else?
  2. What are my treatment options?
  3. What are the pros and cons of my treatment options – do you have the facts and figures to help me decide?
  4. What can I do to help myself and manage my condition?
  5. I would like to talk about my prognosis – what can I expect and what is likely to happen in the future?

Professor Mayur Lakhani, chair of NHS West Leicestershire CCG and a former chair of the RCGP, said: ‘We need to show that the principle of “no decision about me without me” can be part of everyday healthcare. These simple MAGIC cards are a reminder to patients – and to GPs, consultants and other health professionals – that decisions about healthcare need to be made together.

‘A diagnosis can sometimes be a difficult time for patients and their families, who may be concerned about the future and feel confused. They will be able to cope better if they have more information and know the right questions to ask.’

The Government’s ‘no decision about me without me’ policy, rolled out in 2012, means patients referred by their GP should be allowed to choose the provider of their treatment.

Readers' comments (16)

  • Sounds like how to pass your MRCGP but with prompts from the patient. Absolutely the right thing to do and would be beneficial in the long run with happier more informed patients. The difficulty (in my straw poll of 3 GP's) is where is the extra time coming from? When primary care is the repository of all that someone else can't resolve from housing, schooling to work place stress as well as every potential virus or health risk hyped up by the media. I can hear "Go and see your GP they will explain everything" and Dr Google will challenge that explanation, and woe betide if you suggest it may be lifestyle related and advise personal responsibility.

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  • I still can't make a day have more than 24 hours in it.

    What a laugh. Obligate the GP to provide 20minutes of explanation but in the same ten minute appointment.

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  • I'd like to suggest we routinely prompt patients to ring up the CCG and ask them to explain exactly why they are such and interfering annoying bunch of ****s
    (as in the male form of an egg laying hen)

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  • Hello everyone, I am very pleased to explain the background. This is the result of a mortality reviewed carried out in Leicester, Leicestershire and Rutland. This showed serious endemic cultural issues especially across interfaces. For example patients where were at the end of life may not have been identified as such. Or patients with serious illness may not have been aware of the implications.

    These cards are meant to be used in all settings including hospitals, and not just for GPs - in the context of a serious diagnosis being made e.g. dementia, or MND or cancer.

    They are part of a Shared decision making initiative which as the Health Foundation shows has an evidence base for it.

    As a practising GP (in surgery now!) please be assured I am fully aware of the time pressures, these questions do not need to be dealt with in one sitting but support GPs to break bad news.

    I do hope people will accept and look at the research around this, In the long term this sort of initiative improves the d-p relationship and helps to achieve higher standards of modern medical practice. Engagement with patients which general practice is excellent and is the key to the cultural change needed in all parts of our health and care system.

    From my experience, this is exactly the sort of information that health care professionals might want to know/ask ((and do ask) if they were diagnosed with a serious illness.

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  • Our CCG is also endorsing the "Ask me three" national campaign. As an experienced Trainer, I find it very patronising to be told how to consult with my patients. I think most GPs have the training and experience to encourage shared decision making without being spoon fed this sort of tripe.

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  • Shaba, with this proposal you're not being told how to consult with your patients, your patients are being advised how to consult with you. You're right that most of us are great at encouraging shared decision making, but I often find that when I try that I am told "you're the doctor, you decide". This is very trusting but also a bit of an abdication of responsibility. Anything which helps patient realise that actually they have to take ownership is surely a good thing.
    Also to others worried about time, my CSA just a few years ago did require that I somehow squeeze in the chat about the diagnosis, plan and prognosis all in the requisite ten minutes. Not saying I don't find it really hard, but the requirement is nothing new is it?

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  • these are were are taught in Cunsultation skills.PCTs had been advocating doctor controlled consultations which would not lead to patient satisfaction

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  • Its all about simplifying our role Shaba. Doesn't take into account any patient smarter than a beanstalk would think to ask questions, or make a list if they can't remember what to ask, or that any GP who's passed their CSA, would not be able to provide essential information as detailed in MAGIC.

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  • Mayur absolutely Well done for bringing in such a simple solution to encouraging people to devlop the confidence to ask questions - it is not bolshy or time wasting, it is what they need to do. Now let's see the cards actually given out so they can be used

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  • Secure environments GP

    Potentially a positive and welcome move. I can imagine at point of a serious diagnosis this should help, say with a relative present and there is a lot of information to recall. Reading them it reminds me of the way a fully supported patient in an outpatient dept receives a cancer diagnosis. If it used proportionately to circumstances it is a useful aid memoire to both doctor and patient in most other settings as well.

    I think we do have to be realistic under current pressures and have to come up with ways of giving advice that actually makes a difference for patients.

    Ideally a visit with the doctor should be 15-20 minutes (as the RCGP has advocated for some time). Perhaps, only this amount of time can be used to build a very powerful relationship and transfer crucial information that will make our patients healthier. Sometimes a global view of the day and of what is best for as many patients as possible is realistic. There is only a finite about of energy, time and caring that can be done in a day, and whilst every patient should expect this MAGIC card approach is it deliverable?

    The MAGIC cards may give patient's more of a sense of responsibility which with some it does not sit easily. It might give the impression that you cannot trust your doctor to cover or consider these areas so they need reminding. It may highlight a dysfunctional consultation if these areas are not covered OR it may not at all for an otherwise competent clinician focussing his skills across a day of 60 patient contacts.

    I think most experienced GPs practice in the way the questions assert especially if they have longer consultations - 20mins to spare or over several consultations. However I might get a bit miffed if these cards were pulled out every other patient when they have obvious minor illnesses etc and have an expectation I must detail a response whilst I am running 45mins late. We also need to be focussed, pragmatic with our use of e.g the hypothetico-deductive model. Sensible shared decision making is always part of the contract between Doctor and patient. I just hope that doling out these cards all around the waiting room will have the desired evidence-based effect. Because we have so little time, we have to be able to devote our time in a sliding scale of potential seriousness or risk and to the things that will make a difference.

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