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At the heart of general practice since 1960

Goodbye ego, hello better care

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The best doctors in the world still have bad consultations. Sometimes you just start off on the wrong foot. The patient leaving in a flood of tears is usually an indication that this has just occurred.

On one of my medical placements I witnessed one such consultation.

A young woman in the early stages of her pregnancy had a per vaginal bleed and wanted a scan to see if the pregnancy was still OK. Medically speaking, a scan wasn’t indicated as the pregnancy was too early on to detect any changes. The doctors noted the ‘agenda’ as they later remarked, and said they were not going to ‘play the game’ and send the young woman for a scan. She was not happy about this.

Medically speaking, there was nothing the doctor could offer to the woman other than advice to go home and wait a little while before repeating a pregnancy test.

But nevertheless, to me, there was a lot that could have been done. This woman was scared and worried and a sympathetic ear and a tissue would have gone some way to making her feel better. The doctor I was with couldn’t see this. They were frustrated that the woman wasn’t taking their advice on board.

When the young woman began to cry I was waiting for the doctor to hand over a tissue.

‘Any second now…’, I thought, but it never happened. I wanted to give the woman a tissue and put my arm around her, but that would have meant physically placing myself between the doctor and the patient and interrupting a consultation I wasn’t really a part of.

But the truth is, I was a part of that consultation. I might not have been the doctor in charge but I was another person in that room who could have made that situation easier for that patient and I didn’t.

Hours later on my way home, I was still thinking about the consultation. I felt I had let that woman down. I could see what she needed and I sat there and did nothing.

After the consultation I immediately told the doctor what I thought. They took on what I said and agreed with it for the most part. All egos were put aside and the doctor genuinely reflected on how they could have done better in that situation.

It wasn’t about me or them. It was about the patient.

As a medical student it’s easy to feel in the way in the hospital environment or in a busy clinic. When the consultant is running behind, it takes a lot to ask the patients something or butt in and add something you think is relevant that in the end may turn out to be a very trivial thing.

At the end of the day, it’s worth it if it means that there is a better outcome for the patient.

But I regret not handing that patient a tissue. It’s a mistake I hope never to repeat again.

Dr Salma Aslam is an FY1 medical student in Bristol

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Readers' comments (18)

  • Good read - thanks

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  • Wouldn't these essays by baby doctors be better served in the RCGP journal?

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  • When one gets 10 such consultations per day, it feels different.

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  • 11.21 and 12.04 you both remind me of the impatient driver stuck behind a learner driver on a narrow road!!!!

    Everybody has to start somewhere and, assuming you are both GP's you weren't born as Doctors, you trained and then learned to be a Doctor over a period of at least 10 years.

    Give these people a break...........!!! Don't add to the reasons so few wish to become GP's!!!!

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  • Great piece of reflective writing - you'll make a great GP and ignore the compassion fatigue expressed by some.

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  • I have a whole pile of heartsinks that i can pass your way.Let me know when you've finished training.Also it can't just be any box of tissues.Check with the CQC first.

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  • Good reflective piece of writing. You'll make a fine GP.

    And Uhh.... why are so many GP attitudes (as expressed in the comments) so self-centred and grim? If all you care about is your income and pension - please do the public a favour and find another job.

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  • Well I for one think this is a lovely piece of reflective writing.

    As time goes by, I find myself sometimes getting very stressed, and have on occasion deliberately ignored the cues in order to finish the consultation simply because I didn't have the emotional resilience to deal with it at that time. However, I have far more often given a patient a tissue (and often a hug) than ignored these cues.

    The day I don't want to give any of my patients a tissue and a hug is the day I give up general practice. I came into this job to make a difference to people, and by simply being human and responding in a human way, we make a bigger difference than we realise.

    Please remember this episode and reflect back on this lovely piece of writing when you feel low later in your training/working life (which will inevitably happen).

    And please do feed back to anyone you are sitting in with, if they need reminding about the need for compassion. We all started out idealistic and compassionate, and although it may have eroded with time and the pressures imposed on us, it is where we all really want to be.

    Keep up the good work - you will make a great GP.

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  • Yes you'll be a great GP working 2 days a week and with all that spare time you can reflect and then reflect some more and keep on reflecting to your heart's content

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  • and see 32 patients , 2 visits , 10 phone calls , billion scripts , thousands letters and ah , attend lunch time meeting though you will not have the time to eat ergo take paperwork with you.

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