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You've got 10 minutes, then you're out

Banning patients from broaching more than one topic is taking supermarket-style medicine too far, says Copperfield

Banning patients from broaching more than one topic is taking supermarket-style medicine too far, says Copperfield

Should life imitate art or vice versa? I'd like to think that any GP reading the relentless stream of headlines about surgeries in supermarkets would have had the wit to come up with the ‘Four Symptoms or Less' checkout gag.

What I wasn't expecting was that some pioneering spirits would actually take the concept to the next level and, according to a recent Sunday Times ‘expose', erect notices in their doorways discouraging patients from broaching multiple topics during their 10-minute slot. And they don't even get two bites at the cherry; the policy is: ‘One appointment, one patient, one problem.'

Can I just say that I really don't think you guys have thought this through. What we GPs are good at is recognising symptom complexes when regular folk can only perceive disjointed jumbles. We can see the numbers on the Ishihara charts of life where the colour blind can only see the dots.

When a patient kicks off with ‘I'm feeling really thirsty all the time. And I've also noticed…', is any competent doctor really going to say ‘I'm going to have to stop you there I'm afraid, in line with our new time management programme'.

And what if the opening gambit is ‘I think I might have diabetes'? Does that qualify as a single problem and mean that the patient then has the opportunity to mention their thirst, tiredness and polyuria without being gonged off?

Don't think for a moment that I'm siding with the gormless bastards at the Department of Health who insist that ‘GPs are paid enough to make time to listen to patients who have more than one illness'.

We can't make time. We can't make oxygen by photosynthesising or turn base metals into gold either.

Dubious benefit

What we can do is prioritise and we do it bloody well. Admittedly, we prioritise some QOF things that are of dubious benefit to our patients purely because we have to fuel the car, feed the kids and heat the house but by and large our main concern is for our patients' well being. Note the position of the plural apostrophe there - patients include the ones sat outside in the waiting room. That means that we decide when it's time for the patient to move on.

What politicians never seem to understand is that we spend our working day underneath a huge neon sign that reads: ‘Really good stuff free and for nothing. Help yourself.'

Is it any wonder that some patients act like kids in a candy store?

But let's get away from this ‘only one trip to the salad bar' mentality and take the signs down. Let patients know that they can reasonably expect to have 10 minutes with us and then let them figure out how they want to spend it.

I hesitate to suggest that we might learn something from psychiatrists, but they understand better than we do that there will always be unfinished issues when the clock says it's time to call the next patient in.

We should keep control of the game by repeating the following until the patient catches on: ‘We're done for today. We're done for today.'

Otherwise, we're just done for.

Dr Tony Copperfield is a GP in Essex

Is it any wonder that some patients act like kids in a candy store?

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