A tricky consultation with a patient gets GP registrar Dr Nikita Kanani thinking about the crucial role of trust in general practice
From before the television series of the same name began, the phrase ‘Trust me, I’m a doctor’ has held a place in every clinicians consultation. We hope, particularly in general practice, that we inspire trust, and that our patients trust us to act on their best behalf.
1. Firm reliance on the integrity, ability, or character of a person or thing.
2. Custody; care.
3. Something committed into the care of another; charge.
I was struck by a comment made at a King’s Fund conference last week – ‘the minute a patient feels a doctor is making a decision for financial reasons, trust is lost’. Whether this statement is true or not – and I am sure you will all have a view – I was, it’s fair to say, worried. Trust is everything that we as GPs strive to achieve; if we lose the trust of our patients or our population we stop being the face of the community.
Two weeks ago on a Tuesday, I started clinic at 7.30am. By 10am I had seen five children with Hand, Foot and Mouth Disease (HFMD). The signs were characteristic and I felt fairly confident about my diagnoses – mums confirmed that there were local outbreaks.
My sixth child required a different consultation style. Mum had seen my senior partner – much adored by our community (aren’t all senior partners?!) – on two occasions, convinced her son had HFMD. Each time he had reassured her that it was just mouth ulcers, and each time she came away sure her son had just mouth ulcers. When she brought all her children to see me, all with mouth ulcers, some with hand lesions, I readily told her about HFMD. ‘Advised, reassured, provided with a leaflet’. I was about to happily to see her on her way when she asked me if my senior partner had been wrong.
Never a pleasant question.
My patient and I both trust my senior partner, but her trust seemed to be wavering.
I explained that ‘time was the best diagnostician’, that we didn’t know about the HFMD outbreak at the time he saw her and that quite frankly, if he said it wasn’t I would continue to doubt my diagnosis until we had virological evidence. OK, I didn’t say that last bit, but I wanted to.
She eventually left satisfied, her trust in the senior partner reaffirmed.
I have trust in my senior partner’s clinical acumen. I trust that he will take all the facts into consideration when making a decision, and therefore I will support his clinical decisions when appropriate.
Can we expect our patients to do the same?
When we have to place rationing decisions in front of individual patients and their care, assuming our decision-making processes are sound and agreed-upon, should we not be able to justify them to our patients whilst maintaining their trust?
Our patients have always trusted us to make sound clinical decisions.
The reality is that these decisions have always been guided by rationing and funding constraints.
Now my colleagues will set those rationing and funding guidelines.
I can trust them to make sound clinical and non-clinical decisions – therefore I can justify those decisions to my patients, and their trust in us will remain intact.
Dr Nikita Kanani is a GP registrar and joint chair of The Network (networkwithnoname.net).
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