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At the heart of general practice since 1960

Dr Bill Vennells: We need more time to listen

Dear Prime Minister…

’Hello Doctor Bill, it’s not the Black Dog today. The old dodgy back’s seizing up again though, really giving me jip.’

Not verbatim from a real patient but quite typical of many conversations. I might use his first name and we would talk, touching on his world, hobbies and interests that might help him to concentrate and focus on the present, also on his bereavement, confirming his feelings as acceptable and normal, and his back pain, which may come and go, we’d use different approaches to keep on top of it. We’d have one foot in the medical world, mapping his story against NICE guidelines that might indicate a new cancer or an urgent referral.

Not very exciting. Nothing dramatic, but good communication and accuracy are vital here at the start, the heart of the health service. Some see communication skills as just icing on the cake of general practice, something a bit soft and fluffy, but they are essential for doctor and patient to understand each other. People express themselves when they feel listened to.

Mr X above had a psychological reaction to bereavement, and chronic back pain, Ms Y might have disabling pelvic pain, worries about fertility, relationship problems.

’My tummy hurts right low down, burning all day and night. It really feels like somethings wrong, it frightens me. John is no help, he just gets irritable. He told me to shut up yesterday.’

Mr Z may present with chest pain amongst other so far unexplained physical symptoms, a background of stresses and tensions in a competitive workplace.

‘I get this full feeling inside my chest, like it’s going to burst. I feel all tight in my body like it’s all screwing itself up into a ball.’

Unless we have a grasp of our patient’s pain we’re applying broad brush stroke approximations to the truth in our attempts to understand and treat. Don’t underestimate the therapeutic value of feeling connected and supported, or the diagnoses that follow from good quality information from good communication.

At it’s best this is a conversation, valuing the world of the patient’s experience as well as the understanding we have to offer. Medical conditions are interwoven with, aggravated or relieved by, life events.

We can play a major part in developing a good service, using resources judiciously, managing as much as possible in house, locally. The effects of poor primary health care go right down the line to inappropriate casualty attendances, unnecessary admissions, extra use of resources to correct errors and misunderstandings, a poor service that is limping along.

Investment in primary health care and high quality GP training is essential if we are to aspire to an excellent service. This means fostering a culture of openness where learning and teaching are highly valued, actively promoting communication skills and patient-centred values, and fostering training structures that promote teaching by colleagues who are selected and trained as mentors.

Dr Bill Vennells is a sessional GP in Devon

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