General Practitioners
Diagnose, treat and prevent human physical and mental disorders and injuries.
A Tuesday morning in general practice
You are a general practitioner (GP) in a busy suburban practice, seeing a long list of patients with every kind of problem, with a nurse and a receptionist behind you. It is 8:30am. Your list is full until lunch, and a few patients have been added already. You will see people of all ages with all sorts of questions, one after another.
Choose what you would do. Then see what happens. There are often good reasons for each choice.
I've had a cold for three days and I need antibiotics. My last doctor always gave them to me. I have a big work trip next week and I can't be sick. Just write me a script, please.
Write the script, since he's insistent, the trip is important and it's only a minor request
Antibiotics don't work on colds, and taking them when not needed can cause side effects. He feels better in a week anyway, and thinks the tablets did it.
Explain what's likely going on, what will help, and when he should come back
He is not thrilled, but he listens. You give him a clear plan and he leaves reassured. When he calls the next week, he's doing well.
Tell him that antibiotics don't work for colds and ask him to go home
You are right, but he feels dismissed. He goes to another clinic down the road and gets what he wanted.
I've got a man on the phone describing some symptoms that sound worrying to me. He wants an appointment next week, but he sounds scared. You're running late already. What shall I tell him?
Tell her to book him in for next week, since your calendar is full
His symptoms get worse over the weekend, and he ends up in the emergency department. Your calendar was full, but he should have been seen sooner.
Ask Gina to get him to come in today, and see him between patients
He arrives pale and relieved. You find that he needs urgent tests and arrange them straight away. Everyone behind him waits a little longer.
Ask Gina to tell him to go to the emergency department if he's worried
He might need it, but you haven't heard the symptoms yourself. He waits in emergency for hours with something you could have assessed in ten minutes.
I've brought a list of seven things I wanted to talk about today. I know it's a lot, but it's been months since I've been in. The first is my knee, and the second is my sleep, and the third is my mum.
Ask which two or three matter most today, deal with those well, and book a second visit for the rest
She picks her knee and her mum. You give them proper time and set up the next visit for the rest. She says it's the first time she's felt a list has been taken seriously.
Try to cover all seven in the time, moving quickly through each one
You finish the list on paper, but nothing is dealt with properly. She leaves with seven half-answers and a feeling she has not been heard.
Tell her she needs to book a longer appointment and send her home
It's reasonable, but she's waited months already. She leaves frustrated, and puts off coming back.
How it went
When the waiting room is finally empty, you still have letters and results to deal with. General practice is about knowing a little about everything, taking time for what matters most and making decisions with incomplete information. Would you enjoy being the first person people turn to?
This is a simplified, fictional situation to help you explore. It is not professional instruction or a test of your ability.
Case study: The cough and the question at the door
A fictional case set in a busy suburban general practice with six doctors and a full waiting room.
The situation
Dr Ravi Menon had a full Tuesday in a busy general practice. His eleven o'clock patient, Mrs Dalton, had come in about a cough. It was a straightforward visit, and he finished her check in nine minutes. As she picked up her bag, she paused at the door and said, oh, and I've been feeling really flat lately, and not sleeping, but I'm sure it's nothing. Dr Menon's next patient had been waiting twenty minutes. Mrs Dalton was already half out of the room, and she'd said it was nothing.
What they did
Dr Menon put down his pen and asked Mrs Dalton to sit down again. He asked a few gentle questions about how long she'd been feeling this way and what was going on at home. She told him her husband had been unwell and she was carrying most of the load. He didn't try to solve everything in that visit. He booked a longer appointment for later in the week, asked the nurse to apologise to the waiting patient on his behalf, and made sure she had a number to ring if she needed to talk before then.
How it turned out
Mrs Dalton came back and they made a plan together, including some support at home. She told him she'd almost not mentioned it. The waiting patient was a bit grumpy, and Dr Menon said that the cost of a short delay was worth it.
What would you do?
- Why do you think people mention the most important thing at the door?
- How would you balance one patient who needs more time and another who is waiting?
- What can a doctor do in a short visit when a problem is bigger than the time?