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How are you?

‘How are you?’

Seemingly the most innocent of social inquiries, to which the expected answer, 99% of the time, is:

‘Fine thanks, and you?’

As a GP, you’re advised to use this question with care. To a well, stable patient only presenting for a routine medical review, it may be a mere social nicety.

However, posing the same question to a neurotic patient can lead to a long list of complaints and loss of half your consulting time, before they get to the problem they have come about.

For an acutely and seriously ill patient, the question may be a lot more important. We may be asking them about progression or improvement of symptoms, and whether or not the last treatment we prescribed has helped.

From my own perspective, I’m finding that lymphoma is making it very hard to answer how I am. Symptoms come and go, sometimes by the hour, sometimes by the minute. An honest reply to how I am might be:

‘Well yesterday I felt like I was on the wrong side of a ten-pint hangover, but today all I can really complain about is numb fingers, a shooting pain in my foot, and oh yes, the inside of my mouth feeling like a baby hedgehog has had an epileptic seizure in it.’

The patient may or may not have manipulated us

It’s a very difficult question to answer. On days I feel fine and say so, I wonder if people will think that I’m swinging the lead and should get back to work. (I suffer with a pathologically strong work ethic.)

Meanwhile on bad days, I’m reluctant to own up to all my symptoms, in case someone suggests that I should:

A) Stay in hospital

B) Go back to hospital

C) Not engage in the activity I was planning to

I’m beginning to see how we should treat this simple inquiry with caution. As the givers of sick or wellness notes, it’s in our power to use the answer to the question to prolong the patient’s time off work or send them back to the grind. In both cases, the patient may or may not have manipulated us into whatever decision we make.

Maybe, in the spirit of patient-centredness, we should from now on ask:

‘Is there anything you’d like to tell me about your general wellbeing today?’

Dr David Turner is a GP in North West London