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Patient who says: ‘Something’s got to be done!’

This phrase usually comes from someone who feels at the end of their tether. Dr Melanie Wynne Jones explains how to handle such a consultation.

This phrase usually comes from someone who feels at the end of their tether. Dr Melanie Wynne Jones explains how to handle such a consultation.

A patient, relative or colleague who says this to you is either very worried, very dissatisfied or feeling powerless. The unspoken corollary ‘so I'm expecting you to do something about it now' can make us feel as if we, or someone else in the team, has failed or make us feel unfairly blamed or landed with the problem. It can also put us under pressure to deliver. So the first task is to recognise and set aside those feelings to manage later, while we establish what's going on.

Confirm history

You may already be familiar with events, but asking the person to bring you up to date and spell out what's worrying them will ensure you have the full story (or at least their side of it), and what their ideas, concerns and expectations (ICEs) are. ICEs may be a jargon phrase, but unless you know exactly what's bothering this person you won't be able to resolve the situation, and failure to do so may harm the patient, harm relationships or even lead to a complaint.

Hidden messages

Patients who tell you SGTBD may be suffering severe pain or other intolerable symptoms, and be simply desperate for relief. Or they may be worried that their symptoms represent something serious such as cancer or heart disease and have not been sufficiently investigated. One or two will be trying to manipulate you or other people in their lives, and some will keep badgering you for solutions to insoluble problems. Relatives may have the same concerns, or have lost patience with demands that the patient is making on them for practical or emotional support.

Alternatively it might be an unhappy colleague feeling under pressure from patients, relatives, practice members, other parts of the NHS or external bodies such as social services. They may simply want a second opinion or be letting off steam, or they may want you to take the problem over because they are struggling.

So, listen before you speak, ask for clarification and restate the problem back to them to check and signal that you have understood correctly.

Moving forward

Ask the patient or colleague what solutions they have thought of already, and what they think the advantages and drawbacks are for each one. By now you should be in a position to decide whether these would be practical and effective, to suggest other possible solutions or to advise seeking further information or help from others. With luck, the other person will be willing to work with you in negotiating a way forward.

Not taking action

However, you may find yourself having to explain why, although you understand why they feel SGTBD, you have no power to (or choose not to) take action. This might be because all the diagnostic or therapeutic options have already been explored, or because the patient is not willing to explore all of them. It might be a matter of patient confidentiality (you can listen but not comment) or be the case that you can only take action if the patient themselves seeks help.

Writing letters

People sometimes find it hard to understand that we cannot force other agencies such as social services, housing departments, secondary care, the courts, schools, insurance companies and so on, to take the action they desire. Offering to write a supportive letter may defuse the situation, although we must not unfairly raise people's hopes or write anything that we cannot justify.

Summing up

At the end of the discussion, you may agree that SGTBD – or not. Your record of what was said and any action you recommend, take or decline to take should be complete and accurate, as the concerned individual may decide to pursue matters further.

Dr Melanie Wynne Jones is a GP trainer in Marple, Cheshire

Even if you are familiar with the patient's history, ask them to bring you up to date Even if you are familiar with the patient's history, ask them to bring you up to date

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