The Good Doctor Blog: It is called a consultation for a reason….

Blogpost by Dr Emil Shehadeh

“It’s called a consultation for a reason……..

“He was 42 and had chronic intermittent lower back pain, about which he came to see his GP several times per year. He kept obsessing about an accident which took place 20 years previously. He had already had x-rays and an MRI scan, which have revealed nothing. At every visit he would begin by asking for more x-rays.

He was reassured that he had been x-rayed a few times, showing no abnormality. He was warned that more x-rays would do him more harm than good. He had no red flags (symptoms or signs suggesting a serious cause). But he insisted on having more x-rays.

“Consultation” is a word derived from the verb “to consult”, which is defined by the Oxford English Dictionary as follows: “ to seek information or advice from (someone, especially an expert or professional)”.

In a medical context, a normal consultation is a meeting between patient and doctor, in which a patient seeks advice regarding health matters. Consultations in which a patient makes their own diagnosis and determines the course of action, against medical protocol, is not a consultation, or at best a dysfunctional consultation. For a patient to behave in this manner, they have to assume that they know more about medicine than their doctor. Alternatively, they have to assume that their doctor is not trustworthy. If the latter is the case, one must beg the question of why such a patient would remain with the same GP.

It is not unusual for such consulters to have been given the same response by several GP’s independently, and may reflect a belief that all these GPs are wrong and the patient is right. Theoretically, it is possible, and occasionally that may be the case. But we cannot live by exceptions; rather we need to adhere to rules and protocols. The NHS cannot survive for long if it became a fruit machine, whereby clients choose what they want, without any expert advice.

A study published in the BMJ in 2004 showed that almost half of the tests doctors refer patients for, are not needed, though they are perceived to be necessary by patients. This is called patient pressure, which is a strong factor in GP behavior, depending on the individual GP’s personality.

If the public want the NHS to survive and work well, we need to utilize it properly. The consultation is where it all begins and ends. By all means share your views with your doctor, ask questions, challenge opinion, but bloody-mindedness is only going to ruin your NHS. If you demand an investigation when it is not needed, everyone has to wait longer when an investigation is needed. When you visit your GP next, please remember it is called a consultation for a reason!

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