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At the heart of general practice since 1960

The bigger patient picture

It takes more than diagnosing the patient's illness to make a difference – they need educating!

It takes more than diagnosing the patient's illness to make a difference – they need educating!


It was a dark and stormy night. The rain lashed down. A lone traveller made his way slowly along the slippery pavement towards a large and probably listed building. A single, flickering light shone in the darkness. A fresh blast of wind rattled the bare trees and drove rain under his collar. He pressed on, looking up as a single stroke of lightning illuminated the sign creaking in its hinges: Surgery.

Do you ever wonder about events that lead a patient to your door? Could we call it (with a straight face) the patient's 'voyage'? I spent the first few months as a registrar taking straight, hospital-style histories. Any social flavour to them was for amusement en route to diagnosing illnesses (or lack thereof).I am now contemplating the bigger picture. I think that therein lies the rub. As budding GPs, a large part of our role is to positively modify patients' health beliefs. A lot of it is blindingly obvious. You could, for example, mention to a smoker the fact you have to spray air freshener around the room once they leave (or maybe something a little less personal). Then there's the drinker with the alarming LFTs. I know a chap who comes to me regularly and who has also been seen extensively by the hospital consultants. This week, for the first time, he made the connection between the drinking, the varices, the recurrent chest infections, the gastritis, the aches and pains. I personally have probably seen him a dozen times. Which one of us is the bigger fool?

Fear and ignorance

The practice recently saw someone who had been passing frank blood on and off for 18 months. He waited 18 months before seeking advice! Clearly some intense mixture of fear, ignorance and perhaps mistrust prevented him from coming before.

Then there's the reverse, and this is where my motivation becomes a little more personal. There are patients who come to us because the surgery is convenient for the shops. Or there's the patient I saw on a home visit. She had been reassured about her UTI just the day before but felt she needed to be 'checked' again. She confessed she couldn't come to the surgery because she was expecting visitors that afternoon. Well, why didn't she say so? I could have picked up a pizza on my way! That's what I wanted to say but didn't. What I did was to stick a thermometer in her ear, wave my stethoscope near her and say 'I think you're going to be just fine'. What I should have done was sat her down and started a non-confrontational, open discussion to explore and modify her health beliefs so that we can both keep our sanity.So next time, and there will be a next time, I will take a deep breath and do just that.

Dr Geoff Tipper is a GP registrar in Maidenhead, Berkshire

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