Posted by: First 516 May 2016
Throughout my registrar year, it became apparent that there was a particular type of difficult patient consultation which filled me with more dread than someone armed with a Daily Mail article asking for walnuts on prescription. The ‘yes-but’ consultation.
Most politicians are very skilled in the art of question-dodging, but I have never considered its use within general practice
The event which seemed to set this off was a particularly charming young man who turned up as temporary patient and saw me asking for an urgent script of high-dose diazepam. I tried very hard to explain I would need more information and to contact his previous surgery etc., and he did very well to make that difficult. He put me on the back foot throughout: ’Why can’t you prescribe it now? Why can’t you phone the surgery whilst I’m here?’ and so forth. When I tried to answer these questions, mumbling about safety and privacy when what I really wanted to say was that I think you’re trying to pull a fast one, he tied me up in knots. I remember feeling particularly powerless when I explained I would phone his surgery later in the morning because I had other people waiting, to which he replied ’I’m your patient now so I am just as important’. What do you say to that, which doesn’t result in the drudgery of a complaint or a fist to the mutton chops?
I felt incompetent, useless and intimidated. Subsequently whenever similar situations occur – an inappropriate and assertive request for treatment or referral, perhaps – I consider passing wind then ringing reception to ask for some wet-wipes to end the impasse.
During one long week off last October I settled down to watch Prime Minister’s Questions. David Cameron faced six questions from Jeremy Corbyn on the issue of tax credit cuts, and evaded it six times. Asked if he could guarantee that nobody would be worse off as a result of the changes he answered variants of, ’What I can guarantee is [party line]’, ’What I’ve said about this issue is [party line]’, ’What we need to talk about is [party line].’ Most politicians are very skilled in the art of question-dodging, but I have never considered its use within general practice.
A piece of work by Todd Rogers and Michael Norton at the Harvard Business School showed that people often do not notice subtle question-dodging in political debate, but importantly do not devalue the answer given as a result.
I wonder, then, how useful it might be within the consultation. Rather than justify and explain, saying something along the lines of, ’the real issue here is about what time you will come back later today to sort this out’ may have made me feel a bit more competent.
Slippery Dave’s openers are proving useful not just in the denigration of society but in swiftly turning a request for Orlistat into what I can guarantee, which is that with a bit more exercise and a few less cakes Mrs Smith’s knees will feel a lot less better.
So, to answer those who are wondering – how did the original consultation pan out? Well, what we need to do is focus on how to stop this situation from occurring in the first place, and utilise the art of question dodging.
Dr Danny Chapman is a locum GP in east and south Devon