I’m not suggesting for one moment that you patients deliberately irritate us medics. But on those occasions when the GP-patient interaction feels like a battle rather than a therapeutic relationship, it does seem that you’re well stocked with weapons of doctor-destruction. These range from loaded comments (“Thanks anyway, doctor”) to tactical exploitation of the appointment (“While I’m here, doctor”), but the most powerful weapon is The List.
“I don’t come very often,” you say, “so I’ve brought . . . ” “A list,” I interject, wondering if you’ve noticed that my expression has turned from welcoming to adversarial in the time it’s taken you to dig out your piece of paper. You think you’ve been thoughtful and organised; I think you’ve just declared war. The problem is that, in the mathematics of medicine, lists into consultations don’t go. We have ten minutes, and there are at least six problems on your list. Either I end up running horribly late, or you end up with 100 seconds per item. Something’s got to give. And, to me, that’s your list.
Which is why it’s driven into trainee GPs that whatever you do, gain control of the list. There are good reasons for this. For example, a quick scan of the contents may be all I need to make an accurate diagnosis. I might read: “Thirsty, passing urine all the time, losing weight, keep getting thrush.” Which equals diabetes. Or, rather more likely: “Dizzy, tired, palpitations, trembly inside, sore left nipple, wheat allergy.” Which equals neurosis. Had I left this patient to her own list-based devices, I would probably lose the will to live before I’d made the correct diagnosis.
In truth, though, list confiscation is about regaining control of the consultation. Relieving you of your symptom-script gives us GPs the same feeling of relief that you’d experience if you disarmed an axe-wielding maniac. The temptation to tear it to shreds and cackle: “Ha ha! What are you going to do now, sucker?” is almost overwhelming. But GPs are not unreasonable, which is why, instead, we have a quick look and say: “OK, you can choose two of these.” Besides, we don’t always win.
Somewhere out there are secret training camps where patients are taught advanced skills to beat GPs at their own game. How do I know? Because, recently, a patient began the consultation: “I don’t come very often . . .” He didn’t even get as far as: “So I’ve brought a list.” With almost preternatural speed, I relieved him of the paper he was clutching. I grinned a wicked smile as I glanced at the contents. “King Edwards, sausages, baked beans, bread . . .” I looked up, shocked. Now the evil glint was in his eyes, as he pulled a rather larger piece of paper from his jacket. Brilliant! A decoy shopping list! I was so impressed that I allowed him the full 20 minutes to go through each symptom. But he did go home hungry that night.
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Dr Copperfield is an Essex GP. He also writes for Doctor magazine