Time with your doctor is a precious commodity you need to work to your benefit, says Anna Magee
You’ve got ten minutes with your GP, do you spend most of them avoiding your most pressing problem out of sheer embarrassment? Prattling on while their eyes glaze over? Recent research published in The Journal of Public Health found a third of us are reluctant to visit our GP because we don’t want to be seen as ‘making a fuss’. On top of that, the survey of 2,000 UK patients revealed 40 per cent dislike discussing symptoms with surgery receptionists.
Other common ‘perceived barriers’ to seeing a doctor were finding it difficult to secure an appointment with a particular doctor (42 per cent) or at a convenient time (42 per cent). This followed a recent call by the British Medical Association for limits on the number of patients GPs see a day. Doctors are reporting seeing up to 50 – claiming ‘decision fatigue’ could lead to mistakes later in the day as workload intensity increased. To ensure you’re not one of those mistakes, Healthista spoke to leading GPs about how you can, and need, to make the most of your doctor.
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Work the system
Booking systems vary surgery to surgery so find out the nuances of yours – and work it, suggests Dr Hamed Khan, a GP in Norwood, South London and spokesperson for the Royal College of General Practitioners (RCGP). Many surgeries, like Dr Khan’s, book same day appointments and you have to phone in the mornings to make them. But this can be a hassle for busy working people.
‘If you don’t want same day, at our surgery you can get an appointment within 5-7 working days’. Plus, the number of patients waiting a week to see a GP rose by half a million last year, research by the Labour party has found, and waiting lists can be as high as four weeks. ‘We’re also trialing a Saturday morning clinic and two evenings a week so check to see what non-urgent out-of-hours are on offer.’ If you have a choice of time, it’s probably not only better to opt for morning appointments because indeed ‘decision fatigue is a thing,’ he concedes but also for Tuesday, Wednesday or Thursday appointments. ‘Fridays are busy with dealing with residential care homes, nursing homes and secondary care, and Mondays with input from out-of-hours services.’
Some surgeries offer Skype or phone consultations
At some surgeries you can book appointments online through the Patient Access app which also allows patients to view their basic medical records, while others offer Skype or phone consultations. At Dr Toni Hazell’s GP surgery in Tottenham, North East London – like a growing number of surgeries – a system is used called ‘Doctor First’ in which 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.’ This is also the thinking behind your medical receptionist asking the nature of your problem – not just nosiness – and telling them could mean you can book more time.
Know too what you can get that’s non-medical. ‘When elderly people lose a loved one and end up isolated we can help them access befriending services, meals and social activities like walking groups,’ says Dr Golda Parker, an NHS GP practicing across the North West of England. ‘That’s hugely important, especially with widowed men who rarely reach out and for whom loneliness is a growing threat.’
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2. Be prepared
You’ve waited an age to see this man/woman, should you take a list of problems? ‘I love a list,’ says Dr Parker. ‘But they need to read the whole thing out at the start of the appointment,’ she explains. ‘Often the most important is quite low because it’s the most embarrassing and they will sometimes only bring it up as they are leaving!’ Quite often people’s symptoms are related too. ‘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 doctor 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 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’. Sometimes it’s almost like patients are testing you and you have to drag their histories out of them, but this is crucial information we need.’
A symptom diary can help too, says Dr Parker. ‘These are specially helpful for tracking times when symptoms hit such as bowel changes, migraines or the pain of rheumatoid arthritis and some apps out there can make it easier’. Try Symple or WebMD Pain Coach, both from iTunes. ‘Also for blood pressure changes throughout the day, a log is useful but make sure you collaborate your monitor with the practice’s to ensure it’s accurate’
3. Use Dr Google
Google your sypmtoms
‘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. Others Dr Parker suggests are the A-Z conditions listing on NHS, the World Health Organisation 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.
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4. Know what (not) to say
Know what cheeses your doctor off. ‘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 retired GP Dr James Le Fanu. ‘Fine if the problem warrants investigation we can’t do or if we have tried to treat it without fail.’ This could typically be 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. ‘If you don’t need antibiotics, giving you them won’t make something go away faster,’ says Dr Hazell. ‘It can take up to two weeks for a cold to go and taking unneccesary antibiotics contributes to the massive public health problem of antibiotic resistance,’ she says. Common problems antibiotics are prescribed for include urine or chest infections and genuine tonsillitis caused by bacterial throat infections. Something called the ‘centor system’ provides four criteria that warrant 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.’ 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.
Demanding a referral implies your GP is incompetent- it really annoys GPs
Read about a new drug and convinced you need it? ‘A lot of drugs reported on won’t be available to patients yet as they’re still in the approval process,’ says Dr Khan. But if they are, they might not be the most cost-effective. ‘We’ll often choose the cheapest generic version of a drug but the substance will be exactly the same as the more expensive named product,’ Dr Khan explains. Conversely, if you are looking to have treatment that your GP has said is not available, for example for varicose veins which is rarely funded by the NHS, 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, says Dr Street. Likewise, you can opt for a second opinion within your own GP surgery and, if you have been referred to a consultant, are also entitled to a second opinion from one another consultant, 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.
5. Challenge your GP when you need to
If you’re on long-term medication, it should be reviewed every 12 months, which will be flagged up on the white side of your prescription form. But according to Dr Le Fanu, if you’re generally feeling unwell, your medication may be to blame and this needs to be discussed with your GP. ‘GPs are financially incentivised to over-investigate and over-treat their patients and that means millions of people are taking unnecessary drugs,’ he says. ‘That can lead to an overall feeling of decrepitude, aches and pains, depression and people feeling generally under-par.
If you’re generally feeling unwell, your medication may be to blame
If you’re in your 70s and 80s and feeling like that, the chances are it’s drug-related.’ For example, cholesterol drugs statins are known to cause muscle aches and pains and widely prescribed osteoporosis prevention drugs called biphosponates can cause acid reflux and gastritis, he points out. ‘Try simply asking, ‘Dr, I am just under par, I am taking all these pills, I really think I am taking too many, do you think we could start cutting down?’ GPs are sensitive to these things so if they’re challenged they will respond’.
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