Patients, especially those who attend the practice infrequently, often have little idea of whom to approach for their healthcare needs, and are likely to base their behaviour on:

• What family and friends have told them
• What they have seen on TV or read in the paper
• Their previous experience which might be as a child, years ago

It has always been a part of the administrative support staff job role to educate patients about how to use the service and what is available, and this task frequently spills over into the clinician’s interactions. With such high levels of potential misunderstanding in these contacts, it is important for clinicians and the administrative support staff in the practice to be very explicit about what is being offered and whether it is what the Patient expected. Only by asking about this can it be clear.

In some more deprived areas, it is probably true that Patients come to their GP surgery because they cannot find any other help for their problems. That the GP is cost-free is also clearly an important factor. Each Doctor has to make up their own mind about how they meet these challenges.

Patient expects more time than you have

Patients are often more reasonable that might be imagined and may not know about your time pressures. It takes a certain level of experience and confidence before a clinician can ask patients what they think about his/her timekeeping and their view of the time set aside for each meeting. These are questions worth asking.
The standard 10 minute GP appointment is of course intrinsically unrealistic. Would you expect to see your Solicitor or Accountant for just 10 minutes, with an important problem? Is health not more important to most of us than legalities or money? Fortunately, many practices are switching to a 15 minute appointments for routine GP appointments, though maintaining shorter consults for acute problems. Nurses generally have a more sensible approach with time apportioned to the task in hand, but even with this approach can get caught out.
Historically, clinicians in primary care have managed this situation by using:

• Their knowledge of the patient and their family to “cut to the chase.”
• Serial appointments which can be a very effective use of time but is arguably inconvenient for the patient.
• Other members of the team to carry out tasks – delegation.

The following may also help:

• Does your patient know how long their appointment is for? Often, they have only a vague idea of the time allotted. Receptionists can help you by informing the patient, eg; “Thank you Mrs Jones, so that’s at 9.40 on Tuesday for a 10 minute appointment.”
• Offer appointments of 5, 10 or 15 minutes’ duration. Research shows a close correlation between the booked time and the actual time needed.
• If the patient brings a list, congratulate them on being helpful (rather than snatching it away!) and suggest they choose the top problem for you both to address today.
• If a patient feels their problems are being taken seriously, they are more likely to be happy to attend more than once.

Unrealistic expectation of treatment plan

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 general practice clinicians and this may be entirely effective and much less inconvenient for the patient.

Your instinct may well be, “Whoa! 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 job-role expectations

Clinicians are often asked to do things that they 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. For example: “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!

In addition, with a broader multi-disciplinary team working in general practice these days, it is also necessary to gently educate patients that the GP is not the only person who is able to help them with their problem. This can be done by extolling the virtues of a more appropriate clinician or service to help.