Pick a good time, bring your medication list: 18 things to know before visiting a GP

An advice column about what to do in advance of visiting a GP probably sounds odd. However, the experience of some doctors who have retired following a lifetime in general practice shows us that many patients present to their family doctors, in what one UK expert who studied the dynamics of consultations called the “unorganised patient”.

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Time was when the mythology of that relationship demanded that all that was needed was the “Great Diagnostician”, who was a physician blessed with an innate ability to see a problem immediately and prescribe the necessary treatment or cure.

What is needed, however, is not a marvellous diagnostician, but a good “patient manager” who can follow or lead a patient through the process of diagnosis and treatment. Doctors are trained to assess each patient with a short list of different diagnoses and maintain a contact that has an open mind to re-assess and, if necessary, change tack. The too-definite diagnostician can lead to delay and frustration.

Unfortunately, no such magic or magician exists.

There is a feeling that suggests doctors don’t like patients who present with lists. But by all means people should write out their concerns to aid memory. The list must be realistic and, if it is exhaustive, it can be unrealistic to be covered at one sitting.

Some patients feel that unloading a large number of concerns will relieve them of most of them but time constraints mean that a planned approach to these concerns may mean that a number of consults in a continuum will tie the problems together and if possible interweave those that are connected.

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So the most important message is that, apart from emergencies, one should try to plan, try to “organise“, the visit if you can. The least productive visit is the one where the patient states that “they don’t know why they’re there” – or the patient who feels that the diagnostician magician will figure it all out anyway.

The Irish College of GPs Retired Group has discussed these issues and has some simple advice on preparing for a doctor visit. This advice is not rigidly written in stone and won’t solve all consultation issues but may help to smooth the way to better outcomes.

1) Pick a good time

Getting a GP appointment has become difficult, but Friday afternoons – especially those before an extended holiday weekend – can mean that the doctor is rushed or tired, and will not be able to concentrate on the issues.

2) Apply for a long appointment

Many practices will provide a longer time frame if forewarned that more time may be needed for a complex issue or issues. These will be planned for less stressful times in the practice week.

3) Need blood taken?

Bloods have to be transported to laboratories promptly, so evening appointments occur after they are transported. Most bloods are done on patients fasting, so book early appointments.

4) Need a procedure?

You will need some extra time if a procedure is required, such as a smear or an implant. The practice will have special times for minor surgeries or diagnostic mole removal and such like, so alert the practice – the information is confidential. Some vaccinations are done by doctors or nurses at special times. Tropical vaccinations need a consultation as well, as the advice can be more important than the injections.

5) Don’t forget the practice nurse

Many consultations are done by practice nurses and they too need forewarning. They have expertise in a whole range of consults such as vaccinations, maternity care and postnatal issues. They can be good counsellors too.

6) Need a psychologist?

Talking therapy can avoid unnecessary medication or reduce the need for medications. Mental health issues all do better with psychology. Explanation of these issues is therapeutic. Listening skills are crucial.

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7) The pharmacist

Pharmacists are part of the healthcare team and can help with over-the-counter medications and with disease monitors which have become cheap and are reliable.

8) Need a physiotherapist?

Physios can examine joints, necks and spines much better than doctors in most cases and can take more time. Response to physio can be diagnostic and can dictate need for further evaluation such as orthopaedic referral or scans.

9) Chiropodist?

Foot care is so important, yet it is often tagged on to a conversation about other matters. Footware evaluation is crucial especially in compromised patients such as diabetics. Verruca treatment is usually better and a lot less traumatic than cryotherapy.

10) Dissatisfied with your visit? Say so

In a democracy, people can speak out. Some people may have a preconceived notion of the outcome and, if concerned, speak out and seek explanation.

11) Speak of your own expectations

The consultation experts of the 1980s divided the consult into steps – at the end point it is expected that doctor and patient discuss and agree the next step. If you expected a referral to a hospital or for a procedure say so and discuss it. If the agreed next step bears no fruit, the referral will not be refused.

12) You may be recalled

All issues may not be covered in one visit but throwing a line to the next consultation is good for review and follow-up. You may need that long consultation.

13) A trial of treatment is not bad medicine

Following up on a trial of treatment for many illnesses may not only avoid a troublesome referral, but also will help if a referral is eventually needed. Hospitals can be helped if some treatments are tried initially. Getting a recall visit is much more troublesome in a hospital setting so initiating at a primary level can start the process.

14) Bring your medication list

Major problems frequently occur due to prescription confusion. People should carry a medication list to be shown to the GP, the nurse, the pharmacy and the hospital, so correct doses and medications are constantly reviewed. Poor countries are often better at updating health passports with medication lists. Note any allergies and update them.

15) Do you have a thermometer?

If a child is obviously mildly ill try to have the temperature monitored; the response to fluids and anti-fever medications such as paracetamol can greatly help the practice decide on future treatment.

16) Some technology is reasonably cheap and helpful

Blood pressure monitors, thermometers, blood sugar monitors and peak flow meters (for asthma) all help to follow the dynamic of diseases and help in deciding long-term care.

17) The practice staff are human

Practice staff at all levels try very hard in difficult and busy careers to be helpful and caring. Try to understand their stresses, especially in winter. If dissatisfied, discuss with the management and keep calm. It will be better that way.

18) There is no pill for every ill

Most illnesses are self-limiting. Overuse of antibiotics can lead to resistance and other related problems. Try not to demand these, even if a holiday or weekend is imminent. We have to use these only when necessary. Restricting them makes them effective.

We probably need an educational programme to inform the public about improving information about aspects of primary care. The Northern Ireland health authorities had extremely brief and memorable short adverts in the 1980s on antibiotic prescribing and doctor visits that not only helped their GPs but also were quoted outside that jurisdiction.

The good doctor is not necessarily a good diagnostician, but he or she should be a good patient manager and approachable.

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