How to make the most of a GP ap­point­ment

Never book in on a Mon­day, Google your symp­toms be­fore­hand and take a list of ques­tions. Here, lead­ing fam­ily doc­tors ad­vise Anna Magee on how to have a suc­cess­ful visit to the surgery

The Daily Telegraph - - Health & Features - Anna Magee is the ed­i­tor of health­ista.com

GPs spend on av­er­age just eight to 10 min­utes with each pa­tient, and one in four surg­eries now has a wait­ing time of two weeks for an ap­point­ment, ac­cord­ing to a re­cent sur­vey. Yet many peo­ple find that when they get into the surgery room, they’re so tongue-tied – or em­bar­rassed – that they don’t get to the crux of the prob­lem and leave feel­ing none the wiser. Ear­lier this month, the Bri­tish Med­i­cal As­so­ci­a­tion said pa­tients who had morn­ing ap­point­ments did bet­ter – claim­ing that “de­ci­sion fa­tigue” could lead to mis­takes later in the day, as work­load in­ten­sity in­creased. The Daily

Tele­graph spoke to lead­ing GPs on how to have a suc­cess­ful, pro­duc­tive doc­tor’s ap­point­ment.

Work the sys­tem

Book­ing sys­tems vary from surgery to surgery, so find out the nu­ances of yours – and work it, sug­gests Dr Hamed Khan, a GP in Nor­wood, south Lon­don, and spokesman for the Royal Col­lege of Gen­eral Prac­ti­tion­ers (RCGP).

Many surg­eries book same-day ap­point­ments and you have to phone in the morn­ings to get them. But this can be a has­sle for busy work­ing peo­ple, so ask the re­cep­tion­ist what else is on of­fer.

“At our surgery, we’re also tri­alling a Satur­day morn­ing clinic and two evenings a week, so check to see what non-ur­gent out-of-hours ap­point­ments are on of­fer,” says Dr Khan.

If you have a choice of times, it’s prob­a­bly bet­ter to opt for morn­ing ap­point­ments, be­cause “de­ci­sion fa­tigue is a thing”, he says. If you have mul­ti­ple or com­pli­cated is­sues to dis­cuss, Tuesday, Wed­nes­day or Thurs­day slots would be bet­ter, as there will be less risk of a de­lay and your doc­tor won’t be quite as rushed as they would be on a Mon­day or Fri­day. “Fri­days are busy with deal­ing with res­i­den­tial care homes, nurs­ing homes and sec­ondary care, and Mon­days fo­cus on the in­for­ma­tion sup­plied by out-of-hours ser­vices.”

One in four surg­eries now al­lows you to book ap­point­ments on­line through the Pa­tient Ac­cess app, which lets pa­tients view their ba­sic med­i­cal records, and many also of­fer Skype or phone con­sul­ta­tions. Dr Toni Hazell’s surgery in Tot­ten­ham, north-east Lon­don, is one of a grow­ing num­ber of prac­tices where doc­tors talk to pa­tients on the phone be­fore sched­ul­ing ap­point­ments. “If I know the na­ture of the prob­lem, I can book a dou­ble (20 min­utes) or even tre­ble ap­point­ment (30 min­utes) for more com­pli­cated mat­ters such as men­tal health or gy­nae­col­ogy – or if it’s a mi­nor thing like a cold, deal with it over the phone or send them to the phar­ma­cist,” she says. If they need blood tests or chest X-rays I can get them to pick up a form and then see them once the re­sults are in in­stead.” Re­mem­ber, too, that if you tell the med­i­cal re­cep­tion­ist the na­ture of the prob­lem, they can also help to en­sure you get the ap­pro­pri­ate ap­point­ment – and all re­cep­tion­ists are bound by pa­tient con­fi­den­tial­ity.

Be pre­pared

You’ve pa­tiently waited to see your doc­tor, should you take a list of prob­lems? “I love a list,” says Dr Golda Parker, an NHS GP prac­tis­ing across the North West of Eng­land. “But they need to read the whole thing out at the start of the ap­point­ment. Of­ten the most im­por­tant is seen as the most em­bar­rass­ing and they will some­times only bring it up as they are leav­ing.” Of­ten, symp­toms that might seem un­re­lated can be linked, so don’t leave any­thing out, she says. “If they’re not, we can deal with the most ur­gent and then make an­other ap­point­ment for the oth­ers.”

Try pre-empt­ing your doc­tor’s rou­tine ques­tions, says Tele­graph doc­tor Dr James Le Fanu. “Pre­pare answers for: ‘How long has it been go­ing on? Have you had it be­fore and has any­one in the fam­ily had the same thing?’” he ad­vises. And be spe­cific and up­front about your his­tory. “There is noth­ing more an­noy­ing than, hav­ing taken a long his­tory, I’ll say ‘Have you had this be­fore?’ and they say ‘Yes, and I had a num­ber of tests at X hos­pi­tal’.”

A symp­tom di­ary can help, too, says Dr Parker. “These are es­pe­cially help­ful for track­ing times when symp­toms hit such as bowel changes, mi­graines or the pain of rheuma­toid arthri­tis and some apps can make it eas­ier.” Try Sym­ple or We­bMD Pain Coach, both from iTunes. ‘‘It’s also use­ful to mea­sure blood-pres­sure changes through­out the day, but make sure you cal­i­brate your mon­i­tor with the prac­tice’s be­fore you start us­ing it to en­sure it’s ac­cu­rate.”

The Dr Google ques­tion

“Pa­tients who are bet­ter in­formed have bet­ter out­comes, so I en­cour­age peo­ple to Google their symp­toms,” says Dr Parker. But choose good sites. All the medics we spoke to agreed that pa­tient.co.uk was great for ac­cu­racy and read­abil­ity. Dr Parker also sug­gests the NHS web­site, the World Health Or­gan­i­sa­tion, who.int,

If your is­sues are com­pli­cated, Tuesday, Wed­nes­day or Thurs­day are best

and for der­ma­tol­ogy, dermnetnz.org, great for vi­su­als and treat­ment op­tions for skin con­di­tions. Be care­ful though of US-based web­sites, says Dr Mark Street, a pri­vate GP at Spire Health­care, Soli­hull who also sees NHS pa­tients out-of-hours in War­wick­shire. “In the US, drug com­pa­nies can ad­ver­tise and this could skew some of the re­port­ing in favour of drug com­pa­nies that might ad­ver­tise with the pub­li­ca­tion,” he ex­plains.

What not to say

Don’t au­to­mat­i­cally ex­pect a re­fer­ral to a spe­cial­ist or scan. “De­mand­ing a re­fer­ral is a bad strat­egy be­cause it im­plies your GP is in­com­pe­tent and not up to sorting your prob­lem – it re­ally an­noys GPs,” says Dr Le Fanu. Some is­sues do re­quire spe­cial­ist care – such as gy­nae­col­ogy or se­ri­ous eczema or acne – but for con­di­tions like asthma, di­a­betes or high choles­terol you would al­most al­ways be dealt with in pri­mary care.

“I’ve had this cold for two weeks, I need an­tibi­otics,” will also make your doc­tor bris­tle. “It can take up to two weeks for a cold to go and tak­ing un­nec­es­sary an­tibi­otics con­trib­utes to the mas­sive pub­lic health prob­lem of an­tibi­otic re­sis­tance,” says Dr Hazell. An­tibi­otics will be pre­scribed for con­di­tions such as urine or chest in­fec­tions and gen­uine ton­sil­li­tis caused by bac­te­rial throat in­fec­tions. Four cri­te­ria sug­gest a bac­te­rial throat in­fec­tion – tem­per­a­ture, ab­sence of a cough, pus on the ton­sils and lumps in your neck. “If you haven’t got all four – or at least three – then it’s prob­a­bly vi­ral and you don’t need an­tibi­otics,” says Dr Hazell. Dr Street adds that just be­cause you’re see­ing a pri­vate GP doesn’t mean that you can get an­tibi­otics if you don’t need them.

Con­vinced you need a new drug?

“A lot of drugs re­ported on won’t be avail­able to pa­tients yet as they’re still in the ap­proval process,” says Dr Khan.

Get­ting a sec­ond opin­ion

If you are keen to have a treat­ment that your GP has said is not avail­able, for ex­am­ple for vari­cose veins, where few treat­ments are funded by the NHS (un­less they’re caus­ing pain or other symp­toms like swelling and ul­cer­a­tion) – or your GP has told you your thy­roid is okay but you’re con­vinced it’s not, a pri­vate con­sul­ta­tion might help and will cost in the re­gion of £75 – £400 de­pend­ing on area. How­ever, you can opt for a sec­ond opin­ion within your surgery if you don’t feel sat­is­fied, ex­plains Dr Hazell. If you feel you have reached a dead end in your treat­ment and can’t af­ford to go pri­vate, the HDA Pa­tient Care Trust char­ity can pro­vide a free sec­ond opin­ion for a qual­i­fied GP or con­sul­tant within about two weeks (hda­p­a­tient­caretrust.com).

In­creas­ingly, doc­tors are phon­ing, and ad­vis­ing, pa­tients ahead of the ap­point­ment

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