You have been undertaking a placement as a trainee in a practice for three months. A patient comes in for an appointment with you, but then asks to be seen by a senior GP in the practice. How should you react?
Dr Alex Gates: Promote the benefits of seeing a trainee
First try to explore the patient’s reasons. Discussing any previous negative experiences or misconceptions may be enough to allay their concerns.
It is also worth pointing out to them that seeing a younger, less experienced doctor may be advantageous – trainees may be more up to date with current guidelines, and if they consult with a senior colleague for advice the patient benefits from two opinions rather than one.
GP trainees with 20-minute appointments may also offer a bonus for patients who are reassured by a thorough assessment.
Dr Alex Gates is a GPST2 in Bath
Dr Benjamin Rusholme: Reassure the patient that training practices provide quality care
Respecting patient preferences does not mean all demands can or should be met. It is important to inform patients about the role of trainees in providing the service.
Senior GPs take care to guide appropriate patients to their trainees, to help broaden their clinical experience. If the patient is concerned about your abilities you can explain your practice’s commitment to quality, and that trainees are carefully supervised, with responsibilities increased as they gain experience, to ensure they have the required knowledge and skills.
Dr Benjamin Rusholme is a GPST1 in Winchester
Dr Maham Stanyon: Try not to take it personally
This situation can make you feel like you’ve failed – that your advice is not good enough, or that perhaps you did not give the patient enough confidence in you.
However, usually it will have nothing to do with you. The patient will often have their own agenda: for example, they may feel a senior GP is more likely to give them what they want.
Keep in mind that this is no reflection on your ability, as qualified GPs also face a similar scenario when they receive requests for a second opinion.
Dr Maham Stanyon is a GPST3 in London
Dr Heather Ryan: Reflect on what you can learn from it
Your initial reaction may be to feel defensive, but it’s worth reflecting on why the request might have arisen.
There may be something to learn about communicating decisions while maintaining rapport, or a gap in your knowledge that meant the patient went away with unmet needs last time.
The patient may have picked up on a lack of confidence. An important aspect of GP training is learning to manage uncertainty safely and confidently. By the end of training, you need to work as an independent practitioner, albeit one who knows their limits and seeks external guidance when appropriate.
Dr Heather Ryan is a GPST3 in Liverpool
Dr Jason Sarfo-Annin: Be prepared to let it pass
There are two strategies to deal with this situation. The first is to explore the reason for the request and persuade the patient to see you.
The second is to simply honour the patient’s request immediately. Such requests are relatively rare and all doctors have a long career of seeing patients, self-directed reading and attending lectures and conferences. Losing consultations to this is unlikely to make much difference to your skills in the long run and, while the patient waits for a senior GP, you have the bonus of that precious commodity – time.
Dr Jason Sarfo-Annin is a GPST1 in Bristol
Dr Sarah Merrifield: Stick to your guns
Try to communicate firmly and not lose confidence. Despite having less experience, trainees can provide a fresh pair of eyes, which can in some cases improve care. Empathising with the patient may help to reassure them and ultimately prevent a delay in delivering care. GMC guidance states that ‘respect and understanding on both sides’ are key to a good doctor-patient relationship. A joint meeting with a senior partner and the patient may resolve outstanding issues.
Dr Sarah Merrifield is a GPST3 in Leeds