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CAMHS won't see you now

Patients' helpful opening lines

I recently became aware of the picturesque language patients use to start their consultations.

A male patient started his consultation by describing a 'vicious cough'. He was a smoker with bronchitis. An elderly woman complained of a 'piercing pain in her left foot'. This was gout.

A woman suffering from intractable loss of libido complained of being 'dead from the neck down'. A patient suffering from an anxiety disorder complained of 'a massive sense of fear'.

Thinking about patients' opening lines has given me insight into their reasons for attending and the meaning and context of the consultation. This has helped me to understand their health-seeking behaviour and has helped me build therapeutic doctor-patient relationships.

These opening lines are often vivid, and make subsequent inquisition by me less necessary and intrusive. They can also offer significant insight into what is coming next and what is expected of the doctor. GPs know about the nervousness and anxiety felt by many patients before they attend their GP.

Also the careful preparation in constructing their dialogue. And this makes what they say first all the more significant.

The consultation is the heart of general practice. I am struck by how listening really carefully can make things easier.

An important skill that I have learnt, and constantly try to practise, is to say hardly anything at all in the first two minutes or so of a consultation.

Dr Mayur Lakhani

Sileby, Loughborough


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