First They Tell You What to Think, Then They Tell You What to Say

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I got mad consultation skillz

It happened the other day.  I felt like I was sat amongst cyborgs sent from the future – trained to diagnose and investigate.  Lean mean treating machines.

Not many patients realise this, but primary care physicians are trained to communicate with their patients in a very specific way.  We are trained to ask the same things, trained to think the same way and trained to always seem sympathetic even to patients who are incredibly rude.

This is what a typical (fake) consultation (that we are trained to deal with by our training scheme) goes like:


 

Doctor (D): “Hello Mr Smith, what has brought you to the surgery today?”

Mr Smith (MrS): “Well it’s a bit embarrassing, but I have a lump on my, how do you say….meat and two veg…”

D: “Oh dear, I’m so sorry to hear that.  Have you had any ideas as to what this may be?”

MrS:”Well, I’m not sure…..but it’s not normal is it?”

D: ” I see, but do you have any concerns as to why you have a lumpy…..vegetable?”

MrS: “Well now that you mention it doctor, my mothers butchers best friend died a hideous death due to testicular cancer last week.  Now I think I am going to die too.”

D: “Is there anything in particular you were expecting me to do for you today?”

MrS: “I would like an ultrasound please! :)) ”

D: “No problem!  By the way how has this affected your personal life?”

MrS: “Well, now that you mention it, my part time job is as a male stripper.  My very particular clientele have started to notice.”

D: “Oh dear.  Well let me order that scan for you.  By the way if your meat and veg turn black, or drop off suddenly then please seek urgent medical advice.  Cheerio.”

MrS: “Oh Doctor Chowdhury you really are my hero!”


 

The whole consultation model above is predicated on finding out the patients Ideas, Concerns and Expectations.  Theoretically it’s actually quite a good way of approaching a patient, especially since primary care doctors in the UK have a ten minute time limit per patient.  So a way to address the patients concerns as well as extracting medically relevant data to create a management plan seems great.  Unfortunately in the real world the consultation goes more like this:


 

Doctor (D): “Hello Mr Smith, what has brought you to the surgery today?”

Mr Smith (MrS): “I have a lump on my willy!”

D: “Oh dear, I’m so sorry to hear that.  Have you had any ideas as to what this may be?”

MrS:”What?!  You’re the doctor aren’t you?!”

D: ” I see, but do you have any major concerns about this situation?”

MrS: “Huh??!  I already said!  I have a lump on my manhood!!!  Wouldn’t you be concerned?!”

D: “Is there anything in particular you were expecting me to do for you today?”

MrS: “To get rid of this damn lump!!”

D: “No problem!  By the way how has this affected your personal life?”

MrS: “Well, that’s none of your effing business!”

D: “Oh, alright, well I’ll order a scan for you and will see you again in a couple of weeks with the results.”

MrS: “Can I book in with another doctor?  Because you don’t seem to have a clue what you’re doing…..”


 

I’m pretty sure that every GP trainee in the country can relate to this scenario.  I find it amusing that the way we are assessed is by sitting through fake consultations which frankly bare little resemblance to the real world.  Wouldn’t it make more sense to be supervised by trained professionals and if there are any concerns in your day to day job (by the end of which you will have seen hundreds of patients), then these issues can be raised rather than to sit through an exam which costs 1,500 pounds and is arguably biased against Black and Ethnic Minority trainees.

Dr Ramesh Mehta, the President of BAPIO legally challenged the Royal College of General Practitioners on this issue.  The final post graduate exams were then asked to be reformed but the outcomes for Black and Ethnic Minorities are still the same.  (Please see this recent fantastic article by PulseToday: Click Me!).  Dr Mehta believes that the high failure rate need not exist and many capable doctors are being failed at a time when the UK is in a desperate needs for GPs.

In my humble opinion it’s not hard to see why doctors who were not born and raised in the UK would fail scenarios like the ones above.  They already are speaking in a language which is not their first and then they are being forced to communicate in a way which is not even natural or coherent for most native English speakers.  Really, it’s about time we start assessing doctors on their knowledge and real world ability to do the job isn’t it?

 

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