I’m not generally known for my patient-centredness. That said, I’m less draconian than many of you about the one-problem-per-consultation ‘rule’.
I just think it’s unfair, unrealistic and harder to justify now that patients have to wait weeks for an appointment and therefore inevitably develop, say, a vibrating feeling or itchy nipples between booking and being seen.
Besides, if a patient has a list consisting of malaise, blurred vision, dry mouth, recurrent thrush and erectile dysfunction, that’s potentially five appointments before their diabetes gets diagnosed.
I do have my limits, though, as ably demonstrated by a patient I saw today. We galloped through a fungal nail infection, olecranon bursitis, the pros and cons of PSA testing and a cough, and I was feeling pretty slick and self-satisfied. Then, at precisely nine minutes and 59 seconds, he uttered one of the most deflating sentences I’ve ever heard in a consultation. Specifically, ‘Anyway, that’s not why I came, what I really want to know is why do I feel tired all the time?’
The way ahead is to ram home the ‘Ten minutes per consultation’, rather than the ‘One problem per consultation’ message
In the one second remaining, I considered my options and came up with what I thought was the perfect answer: ‘I don’t know.’ This led to the following exchange:
‘What do you mean, you don’t know?’
‘I mean, I don’t know what’s making you tired.’
‘Well, couldn’t you make some effort to find out?’
‘Absolutely, so if you’d like to book an appointment…’
‘I have booked an appointment. This one.’
‘But this one is over.’
‘No it isn’t, we haven’t sorted out my tiredness.’
‘Look, let me explain. If you went into the ‘Pizza for ten quid’ shop, and spent your tenner on a deep pan pepperoni, and when they brought it to you, you said that, actually, that’s not what you came in for, actually you wanted a margherita with extra mushroom, I think they’d be justified in charging you another tenner. Yeah?’
‘But I don’t like pizza.’
‘Look, just sod off, will you?’
Clearly, the way ahead is to ram home the ‘Ten minutes per consultation’, rather than the ‘One problem per consultation’ message. That’s why, on the wall behind my head, right in the patient’s line-of-sight, I’m going to set up a huge digital stop-clock which I will re-set to ten minutes at the beginning of each consultation. It will tell the patient, ‘You have X minutes and Y seconds of your consultation left’. When it reaches zero, it will start flashing the message, ‘You are entering one minute of injury time’.
And if they say, ha, I didn’t come with an injury, I’ll say, no, but you might leave with one.
Dr Tony Copperfield is a GP in Essex. You can follow him on Twitter @DocCopperfield