Posted by: Samir Dawlatly7 April 2015
In 2007, it became compulsory for GP trainees to become a member of the Royal College of General Practitioners and to undertake integrated training, culminating in the award of the Membership of the College. Most trainees spend around 18 months in hospital-based servitude, then learn their trade in the style of an apprenticeship.
Once working in general practice there are several hurdles to overcome: a multiple choice examination, case-based discussions, patient feedback, colleague feedback and the dreaded wallet-emptying Clinical Skills Assessment (CSA), which has itself prompted headlines in the last few years.
Looking back, the over-riding question that I had to ask and answer to pass my assessments was: ‘What does the patient want?’
I also asked: ‘How can I keep them happy so that they complete my patient satisfaction questionnaire?’
I wonder if the question of what the patient wants was asked so much during my training that the more important questions that a GP trainee should be asking get obscured.
I wonder if trainees sometimes forget to ask themselves, ‘What does the patient need?’ or, ‘What is the right thing to do?’
It is a fallacy to assume that making the wants of your patient your primary concern is the correct approach to patient-centred care. By all means, a decent history and assessment may include working out what the patient actually wants from you; I find it helps to know what you might have to turn down from the start (I’m thinking full body MRIs, antibiotics for viral infections and spurious referrals).
There are multiple dangers connected to the excessive emphasis on the wants of patients. It can lead to us feeling that it is our job to meet their demands in order to keep them satisfied, not just for questionnaires but for the Friends and Family Test.
It also means that patients can have unrealistic expectations about what we can actually help with. For example, as a trainee I once found myself acting as a marriage counsellor between two patients, quite by accident.
There’s also a danger that we don’t give our patients the right treatments, or more commonly, we don’t withhold the wrong treatments and thereby waste NHS resources.
Finally, and perhaps most seriously, if we create a cohort of new GPs who feel that they are required to meet the wants and not the needs of their patients, we are setting them up for burnout.
The demands of the job are difficult enough without feeling that you have to please every patient.
Dr Samir Dawlatly is a former secretary of the RCGP’s adolescent health group and a GP in Birmingham.