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At the heart of general practice since 1960

'You may well put your foot in it' - a trainee tutorial from 50 years ago

In a snapshot from a bygone era, Dr Peter Carton-Kelly advises GP trainees how to approach a consultation

The way a consultation goes depends as much on the doctor’s style of listening as on the story the patient is trying to tell. Patients dry up if they think the doctor is not really interested.

Doctors who have been in practice many years have learned to avoid some of the obvious pitfalls, such as the ill-chosen remark, the light hearted comment taken the wrong way or constant interruption.

Trainees, on the other hand, may well put their foot in it, albeit accidentally.

These matters should be discussed so I always include in the training programme a tutorial which I call do’s and don’ts.

This is really a hotchpotch of consultation tips, each tip being used as a heading for discussion. Anyone can make up their own list.


- Remember visiting the doctor is an ordeal for most patients.

- Greet the patient when he comes into the consulting room( Don’t continue writing, looking down at your desk or telephoning without acknowledging the patient’s presence).

- Examine every patient who consults you. This is a must even if the examination is brief. The despair of relatives is found in the remarks: ‘Did he examine you?’; ‘No, but he told me to take this’.

- Remember that the rude and aggressive patient is often a worried patient. An aggressive response is always counterproductive. I have often had an apology from rude patients at the end of a consultation.


- Be irritated by the patient who not only knows what is wrong with him but also knows what the correct treatment is. He may be right so check, then prescribe and/or advise accordingly.

- Be cross with a patient who fails to remember your detailed instructions: ‘what did the doctor say, dear?’; ‘I don’t remember, but he gave me this’ is a well-known home-coming remark.

- Be cross with the patient who does not start treatment immediately.

- Ever use your personal illness or complaint to explain why you can’t help a patient. “I’ve got this too you know and there is no treatment” This is the gospel of despair.

-Explode with rage at hearing: ‘By the way, doctor, would you…?’ as the patient is leaving the surgery. This is probably the real reason for the visit so have him back and start again.

- Adopt hard , fixed  attitudes, for example: ‘you cannot have these tablets because I don’t believe in them’; ‘you don’t need sleeping tablets’; ‘you can’t have a certificate to stay off work as I think you are fit to work’. The soft approach gets the best results. Tablets are reduced prior  to stopping; the disadvantages of sleeping tablets are explained; the certificate is given for a further short period but then it’s back to work.

- Ever forget that the last patient of your working day is the most important patient. Don’t rush the consultation or something will be missed.

Dr Philip Morgan writes:

I came across this article in my late father’s papers. It has no date on it, although it probably was printed in something like Pulse.

Dr Peter Carton-Kelly was a distant relative who was born in Dublin, trained in London before becoming a GP in Hereford in 1952. He remained a practising GP for 30 years and retired just as computers were first being introduced into general practice.

This article is written for trainees of what is now a begone era. However it seems as appropriate now, as it seems when it was first written.

The original article was called ‘Pointers from the consultation - a trainee tutorial’.

Dr Philip Morgan is a GP in Birmingham

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