1. “I've brought a list”
Wind-up factor? Astronomical
What's so annoying about it? The fine balance between providing enough
appointments and making them long enough means that each consultation lasts
only about ten minutes. So having six items on your list - allowing time for
pleasantries and admin - leaves about one minute per problem. You won't feel
that's enough and nor will your GP.
What should you say instead? Ideally, “I've come about only one thing today.”
Failing that, prioritise; leaving that severe chest pain to last isn't good
for your health. Or your GP's.
How to really raise their blood pressure: Precede “I've brought a list” with,
“I don't come very often, so . . .” as if infrequent attenders deserve bonus
time.
2. “I feel tired all the time”
Wind-up factor? Moderate
What's so annoying about it? Partly, it's familiarity. GPs hear this phrase so
often that they acronymise it to TATT. Also, there's the likelihood of
diagnostic frustration: tiredness is common and usually results from
lifestyle issues such as stress and lack of exercise, rather than anything
medical.
What should you say instead? Some variety might help: feeling tired
“sometimes” or “only on Thursdays” would be a refreshing change. And be open
with your agenda. If you're worried you have diabetes, or you want time off,
or you're thinking about vitamins, say so.
How to really raise their blood pressure: Put special emphasis on the words
“all the time”.
3. “I've brought a printout off the internet”
Wind-up factor? Very high
What's so annoying about it? First, I don't have time to wade through 20 pages
of printout. Secondly, there seems to be a link between contentious
diagnoses and the likelihood that patients will turn to the internet for
help. And thirdly, the information, depending on the site used, is likely to
be, at best, misleading and, at worst, dangerous rubbish.
What should you say instead? “I know you won't have time to read this
now; maybe we could discuss it at another appointment?”
How to really raise their blood pressure: Say: “It seems to agree with this
article I've cut out of the Daily Mail.
4. “I want an X-ray”
Wind-up factor? Low to moderate
What's so annoying about it? Patients overvalue X-rays. In fact, for common
symptoms such as back pain or dodgy knees, the results of an X-ray are
rarely helpful. So your doctor's anticipating a battle. The outcome is
likely either to be him waving an X-ray form as a white flag, or you feeling
fobbed off.
What should you say instead? “I wondered if an X-ray might help at
all?” The change in tone from upfront demand to understandable inquiry is
less hackle-raising.
How to really raise their blood pressure: Having listened to your GP's
explanation, say: “OK, I'll have an MRI scan instead.”
5. “I can't swallow tablets”
Wind-up factor? Moderate
What's so annoying about it? This sounds suspiciously like a refusal to comply
with treatment. And if you're honestly trying to tell him that, at your age,
you can't swallow pills, when he knows you can shovel down pizza, you'll
have to excuse his raised eyebrows.
What should you say instead? It's more plausible to try: “I sometimes
have problems swallowing tablets; does it come in liquid form?” But if you
aren't interested in medication, say so.
How to really raise their blood pressure: Emphasise the point with gagging
noises.
6. “I've got toothache”
Wind-up factor? Very high
What's so annoying about it? GPs know as much about dentistry as you do. Just
because we're accessible and can prescribe antibiotics and painkillers
doesn't mean we should be doing the dentist's work. It's not good for your
teeth, and it's not good for your GP's either, because he's grinding them.
What should you say instead? “I'm not sure if this is a dental problem or not.
If it is, I'll see my dentist.” This is so reasonable that he'll give you
whatever you want.
How to really raise their blood pressure: Add, “My dentist was too busy to see
me, so I booked with you instead.”
7. “While I'm here . . .”
Wind-up factor? High
What's so annoying about it? You've cruelly tricked him into thinking the
consultation's nearly over, so he's psyching himself up for the next
patient. Then, suddenly, you drop this bombshell. Because your “While I'm
here” symptom - typically, in men, erection problems - is nearly always more
significant than whatever you've been discussing for ten minutes.
What should you say instead? Forget the preamble, come straight to the point.
Or, if you've just remembered the real issue and time's up, offer to book a
further appointment.
How to really raise their blood pressure: After “While I'm here” say, “I've
just remembered my list.”
8. “I just need a referral to a specialist”
Wind-up factor? Dangerously high
What's so annoying about it? One of the GP's main roles is to sort the
symptom wheat from the chaff. This protects you from unnecessary tests and
treatment and the hospital from inappropriate demand. So this gambit
undermines our vocation by reducing us to the level of post-boy.
What should you say instead? Try a subtler approach which appears to
value your GP: “I know you've tried to sort this out, but I wonder what
you'd think about involving a specialist?”
How to really raise their blood pressure: Add: “I need a referral letter now
as my private appointment is this afternoon.”
9. “Something must be done”
Wind-up factor? Off the scale
What's so annoying about it? The GP knows he's in for a tough consultation as
this is the battle-cry of those who have had enough, of their own symptoms,
or their partner's cough, or their elderly mother's dementia. This
call-to-arms may be understandable but is often applied to problems that
have no easy or instant answer.
What should you say instead? “We've reached the point where . . .” and insert
your demand here. The thrust is the same but it sounds less combative.
How to really raise their blood pressure: Say this at 6.30pm on a Friday, as
the surgery's packing up for the weekend.
10. “I need some antibiotics”
Wind-up factor? Low
What's so annoying about it? This promises another battle, as a demand for
antibiotics is inversely proportional to the likelihood that they'll help.
But the public's appreciation of prescribing now means this is a rarer fight
than it used to be, and one the GP knows he can win, as he has the
prescription pad.
What should you say instead? Try, “I know you don't usually prescribe
antibiotics for this, but I wondered . . .”
How to really raise their blood pressure: Point out that your neighbour has
exactly the same symptoms, was given antibiotics by her GP, and is now fine.
