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Independents' Day

What should I do if a patient asks to see a ‘proper’ GP?

Six GP trainees offer advice

You have been undertaking a placement as a trainee in a practice for three months. A patient comes in for an appointment with you, but then asks to be seen by a senior GP in the practice. How should you react?

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Dr Alex Gates: Promote the benefits of seeing a trainee

First try to explore the patient’s reasons. Discussing any previous negative experiences or misconceptions may be enough to allay their concerns.

It is also worth pointing out to them that seeing a younger, less experienced doctor may be advantageous – trainees may be more up to date with current guidelines, and if they consult with a senior colleague for advice the patient benefits from two opinions rather than one.

GP trainees with 20-minute appointments may also offer a bonus for patients who are reassured by a thorough assessment.

Dr Alex Gates is a GPST2 in Bath


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Dr Benjamin Rusholme: Reassure the patient that training practices provide quality care

Respecting patient preferences does not mean all demands can or should be met. It is important to inform patients about the role of trainees in providing the service.

Senior GPs take care to guide appropriate patients to their trainees, to help broaden their clinical experience. If the patient is concerned about your abilities you can explain your practice’s commitment to quality, and that trainees are carefully supervised, with responsibilities increased as they gain experience, to ensure they have the required knowledge and skills.

Dr Benjamin Rusholme is a GPST1 in Winchester


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Dr Maham Stanyon: Try not to take it personally

This situation can make you feel like you’ve failed – that your advice is not good enough, or that perhaps you did not give the patient enough confidence in you.

However, usually it will have nothing to do with you. The patient will often have their own agenda: for example, they may feel a senior GP is more likely to give them what they want.

Keep in mind that this is no reflection on your ability, as qualified GPs also face a similar scenario when they receive requests for a second opinion.

Dr Maham Stanyon is a GPST3 in London


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Dr Heather Ryan: Reflect on what you can learn from it

Your initial reaction may be to feel defensive, but it’s worth reflecting on why the request might have arisen.

There may be something to learn about communicating decisions while maintaining rapport, or a gap in your knowledge that meant the patient went away with unmet needs last time.

The patient may have picked up on a lack of confidence. An important aspect of GP training is learning to manage uncertainty safely and confidently. By the end of training, you need to work as an independent practitioner, albeit one who knows their limits and seeks external guidance when appropriate.

Dr Heather Ryan is a GPST3 in Liverpool


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Dr Jason Sarfo-Annin: Be prepared to let it pass

There are two strategies to deal with this situation. The first is to explore the reason for the request and persuade the patient to see you.

The second is to simply honour the patient’s request immediately. Such requests are relatively rare and all doctors have a long career of seeing patients, self-directed reading and attending lectures and conferences. Losing consultations to this is unlikely to make much difference to your skills in the long run and, while the patient waits for a senior GP, you have the bonus of that precious commodity – time.

Dr Jason Sarfo-Annin is a GPST1 in Bristol


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Dr Sarah Merrifield: Stick to your guns

Try to communicate firmly and not lose confidence. Despite having less experience, trainees can provide a fresh pair of eyes, which can in some cases improve care. Empathising with the patient may help to reassure them and ultimately prevent a delay in delivering care. GMC guidance states that ‘respect and understanding on both sides’ are key to a good doctor-patient relationship. A joint meeting with a senior partner and the patient may resolve outstanding issues.

Dr Sarah Merrifield is a GPST3 in Leeds

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Readers' comments (7)

  • don't worry about it guys. I am 6 years post qualification and I still get told that patients want to see the senior partner! it's all good. the key thing is that a patient should be satisfied and have confidence in the care that a clinician will deliver for them. if some people choose to not see you, then really don't worry as their are literally thousands of others that do!

    - anonymous salaried!

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  • Smile inwardly, explain that's fine, point them outside to book with a proper GP all the time knowing that its the same sense of self entitlement that bounced from the Practice Nurse to the ANP to the registrar to the partner to the senior partner and on to a Consultant and then even a professor all usually for a minor condition.
    I sometimes get the "I just want referring" which I do, but then when they ask for my opinion I gently reflect their chosen course of action to them. I have to take issue with the suggestion of a "Joint meeting with a senior partner" that's just pandering and reinforcing behaviour.

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  • you are a proper doctor, you have training and are fully gmc registered. thats what i said when a trainee. then gloss over it and get on with the consult - if they wont then id say they are free to book again, but i wouldnt let them see someone else the same day - it would need to get booked as per everyone else - no special treatment.

    its different if as a trainee you need assistance or a second opinion.

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  • Can we have an answer that doesn't contain the word 'reflect'. .....

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  • Easy. Ask them to go the front desk and make an appointment to see the Dr that they should
    have asked for in the first place. They might have to wait a week or two.

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  • Nothing changes - I remember patients declining to see the "YTS doc" in the 1980s.

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  • Response- that's fine . Please go to the reception to book to see the GP of you choice. Then first opportunity you get move to Rural Australia or Canada and when you get asked the same question- say that's fine I am the only doctor in this 2 hour radius, you can head to the next clinic 2 hours that way and book to see the GP of you choice.

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