I met an old GP who told me the story of when he worked in A&E many years ago as an SHO. There were some army officers posted in the department getting experience; working with the paramedics and doctors. Because of his junior position, his patients would frequently ask for a more senior second opinion when he had found nothing wrong and wanted to discharge them. His lofty consultant often dismissed him, but he found if he could convince one of these army officers to go in with his uniform on, and give a quick nod to proceedings, their presence would usually ensure the patient would go home satisfied. Despite this being a morally questionable scenario, it presents us with the fact that there is something about the way a patient responds to us that is out of our control.
A particular challenge for me as a GP trainee starting consultations is with parents. They often want to see a 'family doctor' with children of their own in order to feel reassured about the state of their own well child. Sick children can make the most seasoned GP’s worried, but I have found the uncertainty of paediatric consultations to be the most intimidating, and have seen colleagues with their own children have a different air of confidence.
After looking into this I have decided it is not just a case of ‘looking the part’ or ‘playing a role’, and without my own uniformed reinforcements to turn to, I have found some practical pointers for trainees in a similar situation.
First, remember the delicate doctor-patient relationship in a paediatric consultation involves treating both the child and the parent. It is essential to draw on the experience of colleagues, most of whom have plenty of experience of the spectrum of well to very unwell children. Disproportionate worry may necessitate probing a bit deeper, e.g a parent with a previous child who had viral meningitis that presented very similarly to this child that you feel has a head cold. Safety-netting is key, most parents will respond well if they go away with options for what to do if it is not getting better, or getting worse.
I don’t have experience from having my own children, but I have also never had hypertension or heart failure. I believe that as we start out, our ability to reassure need not solely rest on our own experiences, at least those of us without friends in the forces.
Dr Martin Wicks is a GPST1 in Bristol
