As a GP you can get support from colleagues both in the practice and outside. I was discussing patients who won't take advice with my helpful partner Martha, and told her about a patient I remembered who had required an operation urgently but told me she couldn't go along with the arrangements I wanted to make because of her work commitments. Martha told me that something similar had happened to her many years ago: she had been given medical advice which clashed with the plans she had already made for her life. Sensibly the consultant suggested that she take some time to think about things, and of course in a little while she realised that the consultant was right and took his advice.
In the case of emergency, perhaps a serious accident or a heart attack, the patient realises immediately that they have to put their normal life “on hold” for a while. But when the medical problem is less obviously urgent it can take time for patients to realise that they have to give their treatment some priority. We try to shoehorn so much into a brief consultation, and our thoughts race ahead thinking about likely outcomes and the best options. And of course we don't know all the details of our patients' lives. It's hardly surprising if the patient's thoughts are a little behind ours. Under such circumstances it is often helpful to arrange a second consultation a little later. We don't even have to say “go away and think about it before I see you again” because the patient will do that anyway. On reflection this is probably one of the reasons that diagnosis and management of puzzling cases become easier the second time I see the patient. Not only have I been thinking about the problem subconsciously, but the patient has almost certainly been doing some thinking about what was said and implied during the first consultation.
I got some good support from a hospital colleague yesterday when I saw a patient with a bad attack of erythema multiforme and really nasty mouth ulcers, but otherwise not looking too unwell and with no fever or systemic upset. I brushed up my knowledge of this condition and its more worrying counterpart the Stevens-Johnson syndrome (suggested by the mouth ulcers) using GP Notebook, but I wasn't sure about whether to prescribe steroids. I rang the dermatology Registrar on call who sounded very young and slightly worried, as though she had a bit of the imposter syndrome herself. But she gave me excellent advice (don't give steroids, Difflam mouthwash for pain relief, ring the out-of-hours service if things deteriorate over the weekend and ask them to call her) and has arranged a clinic appointment on Monday morning. She also took my patient's telephone number, and I think she is going to ring over the weekend to check that things have not got worse. Now that's what I call good service!