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How to say it: useful forms of words for common situations

GPs who are new to the specialty often struggle to find the best words. It is not easy to break away from the safe medical-speak we've all been taught. But in general practice, success often depends on expressing yourself in your own language.

This section of the Library of Solutions is populated by other people's experiences. Below are just a few ideas which may or may not be useful to you.

We want to hear, and will publish anonymously, your own experiences in this critical and very individual part of GP work. Please visit the Garden Shed if you would like to contribute.

General

Avoid conveying responsibility for things outside your control. Using "They" rather than "We" can help here:

"They think it is important to have regular blood tests if you take Warfarin."

Again using the second person is very effective at reducing any potential conflict because it puts the patient at the centre of the discussion.

"You might like to consider taking the antibiotic prescription and only use it if the throat is not better in 3 days, as you seem to be someone who is careful about not taking tablets unnecessarily."

To help your message be received as positive, NLP (for instance) suggests taking care over "but" and "and":

"The 10 lbs you have lost is an excellent start, but I'm sure you can achieve even more." Comes across as "Not brilliant - can do better"

"The 10 lbs you have lost is an excellent start, and I'm sure you can achieve even more." Comes across as "Doing well, will certainly achieve more in time."

The masters of consultation skills are of course the TV chat show hosts. And no-one will know you're plagiarizing them!

Although video consultation analysis seems to belong to those in training, it is a very useful and satisfying tool for mature practitioners as well!

Helping a patient accept that a problem is self-limiting

"Luckily your body's defences are usually more than strong enough to combat this type of infection…"

"They do say that you don't normally need antibiotics for this, and I must say that the people I've seen with it actually have all got over it without any."

Ask a series of questions which you know will have the answer No:

"You're not a diabetic are you?" "No Doctor."

"You don't have asthma as I recall?" "No Doctor."

"You're not on any tablets that affect your immunity are you?" "No Doctor." "Well luckily then it's very unlikely you'll need special treatment for this…"

Encouraging a patient to help themselves and to own their problem

As above, but also:

Rather than the medical "we", again use the second person: "How can you move forward with this now" rather than "How can we help you…?"

"What have you done so far to reduce the stress in your life?"

"These antibiotics can help your immune system fight off the infection, but it's your immunity that actually does the work!"

"I am certain that you will be able to lose weight if you work at it, and our advice is only needed to get you started.

Tackling a subject the Patient doesn't want to hear

The priority, even though it may be uncomfortable for both of you, is to find out where they are coming from:

"What do you think is behind this problem you've been having with dermatitis on your hands since you became a hairdresser…?"

"What do you think is really causing you to have such a problem losing weight…?"

Of course you then have to react to the unexpected attitudes this may reveal, only be sure to align yourself with the patient not against them:

"You are basically a very fit person, so the dermatitis is unlikely to be caused by a blood disorder; but if we're to sort it out I'm sure you'll agree we need to nail the real cause? Would you be able to try wearing a glove on one hand when you're at work for a few days…?"

"You are quite right, we should certainly be doing some tests to make sure your glands are functioning well before we look at other causes of being overweight…"

Timekeeping

There is never enough time to do the job really well, or that's how it seems. But it takes two, so perhaps start with identifying what the patient thinks about the time aspect of their consultation:

"Did they tell you how long the appointment is for today?"

"Do you normally find we have enough time at your appointments?"

"We've only got 10 minutes, so what is your really important concern today?"

Patients generally can spot whether their problem is being taken seriously, and this is a good reason for wanting to give them more time than you may have at the first appointment:

"I can see that this is something that has been worrying you, and although I'd be surprised if there's a serious problem causing it, we still need to get to the bottom of it. So now you've given me a good description of what's been happening, may I suggest you make a further appointment so that I can give you a proper examination and then talk further about anything we need to do?"

Finally, if a patient is really difficult to close a consultation with, there may be other reasons - see Heartsink and other challenging patients

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Unrealistic expectation of referral

It often happens that a patient - maybe someone who doesn't come to the Doctor very often and is essentially unaware of the way GPs work - will initiate the consultation with something like, "I've come for you to refer me to a specialist because of my eczema. I've tried all the creams I can get from the Chemist. I've been told you just have to write a letter for me.

In other words, they are unaware that their problem is usually treated by GPs and this may be entirely effective and much less inconvenient for the patient.

Your instinct may well be, "Woa! Hold on a minute!" But it often works well not to be in any way negative at this stage. Your task is to turn around the super-tanker, not to blow it out of the water.

Even though you may be thinking "No", the word "Yes" can be very helpful here: "Yes, we can certainly think about that. But tell me a bit more about the problem first… For example, have you tried using a steroid cream regularly for 2 weeks?"

Inappropriate expectations

GPs are often asked to do things that GPs don't normally do as part of their job description although this sometimes feels almost infinite in scope!

The sense that we are being asked to do something outside our remit can be very subtle at least initially.

"Doctor, You have been kindly treating me for my depression. A large part of it is my noisy neighbours. I really need a letter to them pointing out that they are making me ill. I've brought something I printed off - all you need to do is sign it. Goodness is that the time? I must be off - can you just put your squiggle here…?"

A good tool here is summarisation: "Just to summarise what you have said, you wish me to sign a letter that you have written to a member of the public who you think is making you ill…"

This should lead towards an equally clear, "I regret I cannot help you. This is not part of what Doctors do." Using "Doctors" rather than "I" may help prevent the patient going to each of your colleagues in turn!

Dr. Cameron might also provide interesting food for thought with some adapted real GP scenarios.

If you'd enjoy the exercise, see what you think and what you might do and say.

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