Quite often the patient's view of what went on during a consultation differs from the doctor's. At worst this can lead to complaints and even legal action, but usually the consequences are not so serious. Often neither doctor nor patient are aware of these differences of understanding, but today I had two consultations where they came to light.
The first was with a woman who has been suffering from back pain for a few weeks. She is on warfarin which means that she can't take drugs like ibuprofen or diclofenac for the pain, so one would consider prescribing paracetamol and possibly a codeine-type of drug as well. She told me that she had seen my partner John a week ago but "he wouldn't give me any tablets for it because of all the others I'm on". However, on looking back at John's note he had written “she is not keen to take even paracetamol as her INR [warfarin monitoring test] has been erratic”. Both recalled that the other had been reluctant. Of course John's note was written immediately after the consultation, while the patient had had a week for her memory grow hazy. But I suspect that even if you had asked her immediately after the consultation her recollection would have been the same.
John is not the only doctor who sometimes has a misunderstanding with patients. I do too, as do all doctors from time to time. My second patient was a man whom I am currently investigating. The last time I saw him I had asked him to have some blood tests before we met again. Today he apologised for not seeing the nurse for the tests but his peripheral veins have all been thrombosed by repeated injections. “I tried to tell you last time” he said, “but I don't think you heard me”.
I have no memory of our previous encounter at all, for it was several months ago. I must have been thinking about his other medical problems and what we should do about them. Patients frequently complain that the doctor didn't listen to them. Often it is true, but that doesn't mean that they were being deliberately ignored. I was so busy trying to sort things out for my patient that I didn't hear what he was telling me.
I wonder whether the changes in general practice have made this more likely to happen. We now do a lot of chronic disease monitoring that used to be done in hospital out-patients, and have a lot of information to gather and record on the computer to gain our QOF (Quality and Outcomes Framework) points. Often we are so obsessed with these matters that we do not give the patient our full attention. Sorry, what were you saying?