Dr John Allingham’s article was judged ‘highly commended’ in our clinical writing competition.
‘It’s me town halls doc, I think I might be a jaffa.’ As consultation opening gambits go, this is my all-time favourite.
The patient was a heavily muscled guy in workman’s clothes. I had only met him once before. He walked into my office, sat down and without any exchange of pleasantries offered that rather startling sentence, then waited for my reply. I hesitated, open mouthed, while it sank in.
Fortunately, I knew town halls could be used as rhyming slang for balls and a jaffa is a seedless orange. So I figured that the patient was concerned his testicular problem might have rendered him infertile.
The consultation that followed lasted less than the 10-minute standard and was a quick and simple determination of his epididymitis, with reassurance about his fertility and formulation of a treatment plan.
Today’s medical students have regular sessions in communication skills, so teaching registrars that if you listen to the patient they will tell you the diagnosis is preaching to the converted. But it still surprises many how little time a patient will speak without seeking input from the doctor. I have recorded patients’ opening uninterrupted speech on numerous occasions and asked trainees to estimate their length. The error rate is close to 100%. Most patients struggle to exceed 30 seconds, but to the doctor that feels like at least a minute.
Becoming a listening doctor
If you are a GP who has forgotten, or was never taught, to let the patient speak without interruption – try it.
After the exchange of pleasantries say something like ‘How can I help you?’ or ‘What brings you here today?’ and sit back and wait. It doesn’t make for over-running surgeries, helps gain a reputation as a listening doctor and even when of no clinical value provides entertainment.
And it is important, too, to try to understand the language patients use and to speak to them in a way they understand. I don’t mean that we should be fluent in everything from Pashtun to Gaelic, but that we should recognise how they use words.
‘I feel dizzy’ might actually mean ‘I am about to fall over’, ‘I am about to faint’ or ‘I am stupid’. It is easy to make a mistake, but just as easy to learn how patients speak and to remember it.
Teenagers who say it ‘was like a sore throat’ actually mean it was a sore throat. The lady who wanted fibreglass for her constipation didn’t want to chew the insulation, just a script for Fybogel. Her colleague who came to discuss her ‘polly-go-lightly’ was reviewing her steroid dose for her polymyalgia.
We have all been told it before, but in the mess of bureaucracy, data collection and point collecting that is each consultation we can forget that listening to the patient and understanding what they are saying is time well spent.
Dr John Allingham is medical secretary of Kent LMC and a GP in Dover