Doctor, Doctor

‘All patients are vulnerable and apprehensive,’ says Mr Padraic Reagan, a consultant plastic reconstructive and hand surgeon at University Hospital Galway and the Bon Secours Hospital. ‘We [as doctors] are in a wonderfully privileged position that we can help people and that they place their trust and confidence in our skills.’

‘All patients are vulnerable and apprehensive,’ says Mr Padraic Reagan, a consultant plastic reconstructive and hand surgeon at University Hospital Galway and the Bon Secours Hospital. ‘We [as doctors] are in a wonderfully privileged position that we can help people and that they place their trust and confidence in our skills.’

Medical advice columnists in newspapers and magazines are inundated with queries. People too scared or embarrassed to approach their doctor about some worrying medical problem find it easier to put pen to paper and confide in a total stranger.

People avoid visiting their doctor for a variety of reasons. Some are worried about the confidentiality aspect because their doctor is a neighbour/family friend. Others believe they have some serious medical condition and are afraid the doctor will confirm their worse suspicions. Still more are embarrassed about sharing their problem or having an intimate examination.

Fear tends to be a major factor, says Mr Padraic Regan, a consultant plastic reconstructive and hand surgeon at University Hospital Galway and the Bon Secours Hospital.

“It’s fear of the unknown, fear of what might be wrong, fear of bad news. If a patient had a relation with a similar problem and did not do well they might extrapolate their own symptoms to fit the other person’s and fear they are not going to do well either. I hope it’s not the cost factor but it could be in the current climate.”

Attending a specialist can be even more daunting for a worried patient. “GPs oftentimes will have forewarned patients, they sometimes come with a presumptive diagnosis and very often it is correct. That ups anxiety levels.

“Patients can feel more unsure going to a specialist, more frightened. They are going to a new office or a hospital and this unfamiliar environment can heighten anxiety. They are going to see someone they never saw before and give them personal details about themselves. GPs are wonderful people, they know their patients very well and can reassure them about who they are going to see.”

Be prepared

Mr Regan believes it is a good idea that patients think through their concerns beforehand and maybe write out a list of symptoms and questions they want answered. That way, they can be sure that everything is covered. Writing down fears or worries often prompts them to mention them, too.

“A lot of people bring a list of concerns with them and that’s no harm. They can use it as an assessment of the consultation as well. Did he cover this or that? People should be encouraged to do some research into their condition. Many will have researched it on the internet, sometimes over researched it!”

While patients may understand the instructions and advice at the doctor’s office when they go home they can get confused. So, it’s a good idea to bring a friend.

“I think it’s important for complex procedures that you have patient information leaflets. It is important to go through procedures in detail with patients.”

In the past patients tended to be overawed by doctors, especially consultants, and many felt they did not have a right to question them or state their preferences or wishes.

“That may have been true in the past,” explains Mr Regan. “But it has changed significantly now. You shouldn’t have a situation where people are afraid to ask a question.”

He says the main stumbling blocks to a good doctor/patient relationship are fear, mistrust, previous experiences and unreal expectations.

Good communication skills are essential when dealing with patients, he says. “You need to be able to communicate verbally and through eye contact. It’s a given that we all have the knowledge and technical ability to inspire confidence in patients. All day you are seeing or operating on patients, you are communicating with them all the time. You’ve got to be reassuring. Everybody reacts differently, some people are scared out of their wits.

“All patients are vulnerable and apprehensive. We are in a wonderfully privileged position that we can help people and that they place their trust and confidence in our skills.”

Bad news

Honesty is an important trait, especially if a doctor is breaking bad news, says Mr Regan. “You always break bad news in the company of loved ones. You are always gentle about it, you go through the history of it [the condition] and where they are at now.

“Honesty is very important whether you drip feed it or blurt it out - drip feed probably more than bluntness [is the preferred way]. You have a certain amount of anticipation how certain people are going to react, you can gauge how much people want to know. The question ‘How long do I have?’ is often unanswerable.

“Some people are copers, some are not. I don’t think anybody copes very well with bad news. It is always very important that you don’t remove all hope, that people have something to cling to.”

Research indicates up to 40 per cent of patients do not tell doctors everything they should. “There is a skill in gleaning information from patients. It is important not to have tunnel vision, that you are open to things going on in their lives which may crop up during the consultation. There are always other things going on in patients’ lives which may mitigate against the real answer.”

How do you select a doctor? GPs say most people come to them through personal recommendation. Important considerations are the doctor’s type of personality, location, opening hours and policy on home visits.

“Pick one whose personality will fit easily with you,” advises Dr Greg Kelly, the former clinical director of Westdoc, the out-of-hours GP service.

“Like all relationships there’s a certain chemistry in all doctor/patient relationships. Certain people will get on well with one another. It is important you feel comfortable with your doctor and that there is mutual trust and respect, that there is openness and honesty and that information is not withheld by either side. It may be necessary to try out a few doctors before you get one that suits.

“I often tell this anecdote. I was going on holidays and a patient of mine asked about my locum, ‘Is he nice?’ not ‘Is he good?’ That word [nice] is very important to patients and applies very much to general practice. You can attribute 90 per cent of your success as a GP if you can fit that label.”

Self diagnosis

He advises patients to give “a good history” of their complaint when attending the doctor.

“If you are not good at that write down some thoughts and whatever questions you want to ask before you come in. Be conscious of the timescale of the consultation too, the average GP visit is 10 to 15 minutes. Do not store up a list of old complaints and present them in one visit when you are presenting with an acute complaint. That is not fair on the doctor or on the other patients waiting. Be sure to ask questions and contact the doctor if your condition is not responding as planned.”

While patients today tend to be better informed about health matters because of the internet Dr Kelly cautions against self diagnosis.

“Information is always a good thing. However, sometimes the information you get can cause people to panic. Very often it’s a worst case scenario situation. If you have rectal bleeding for instance and you look it up on the internet bowel cancer will come up when in fact for the vast majority of patients it’s haemorrhoids. The internet is OK to a point but you must realise it’s a general thing, it won’t make a specific diagnosis.”

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