Monday, 19 March 2007

Good news

This morning I rang the radiology department about the chest X-ray report I mentioned on Saturday. A charming young radiologist confessed she had forgotten to add the line "no appreciable change since the last film seven years ago" to her report. I told her the story about the poem to show there were no hard feelings. This evening I rang my patient to let him know. He was grateful, and expressed surprise that I was still working at 7pm after a 9am start. I had to tell him that I considered getting away as early as 7pm to be a bonus, and he promised not to rib me about my colossal income in future.

Chatting to one of my older partners at lunch-time, I realised that she was feeling a bit like I did last summer, having difficulty keeping her head above water with all the changes. In particular she has found the management of CKD (chronic kidney disease) difficult to get to grips with. This is another complex set of tasks that we have been required to implement this year. I tried to be supportive with helpful remarks. She also expressed some sorrow at the way general practice is heading. A patient and dear friend of hers, who moved out of our area, is not getting on well with the young doctors at her new practice. Like our own young partner they have brisk and businesslike attitudes.

I've been pleased with my attempts at altering my consulting style which have gone well today. Admittedly I was helped by having relatively light surgeries, but I kept to time better and never ran more than twenty minutes late at any stage. In particular, I have gently taken a little more control over the consultations. When I was a trainer I used to teach my Registrars not to interrupt the patient for at least the first minute. The theory went that "if you ask questions you will only get answers" and that patients will not only provide you with most of the information you need spontaneously, but also indicate what is really worrying them. Up to a point, Lord Copper. I fear that I have tended to take that advice a little too much to heart, and allowed consultations to ramble on. Perhaps a little late in the day, but better late than never, I am learning to take control after the first golden sixty seconds and to ask the patient bluntly what is worrying them. I also find myself explaining more and growing in self-confidence as I do so. Sounds marvellous - but I know it won't last. I've been here before.


Anonymous said...

You say:

"she has found the management of CKD (chronic kidney disease) difficult to get to grips with"

What makes management of CKD difficult for GPs, and (how) can patients best help?

I do hope you will be able to spot, and choose to respond to, this comment, even though you made the original post a long time ago. I do think you blog is very worthwhile, even if the audience is as yet still fairly small.

Dr Andrew Brown said...

Much of CKD is not actually a disease at all, but a situation which might represent early disease that could deteriorate. The test (eGFR) is unreliable. Large numbers of patients are involved, and have to be repeatedly tested. And it is difficult to get the few patients who do develop kidney problems seen at the hospital because they are overwhelmed by referrals.
Patients can best help by smiling sweetly when their doctor looks stressed. :-)