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
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.
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