Didn't do 3 yrs voc training, I only did one. (1 year A&E is now acceptable
towards it too). And you're making the usual mistake of thinking that the
GP 'way' is asking about all the psych/soc stuff. What I mean is finding
out what the patient is actually worried about and reassuring those
specific worries, even if from the doc's POV they are entirely irrelevant
concerns. And yes, where necessary I can fit it into a busy shift (last
week I was running the dept with 1 SHO from 9-5; the hospital is a tertiary
centre and we see 62,000 a year). I believe it pays off in the long term.

And I was talking about *good* GPs, not the 1 prescription per patient
variety.

Yes, I did mean Bedford.

Fiona.

>----- Original Message -----
>From: "Fiona Wallace"
>Subject: Re: Decline of Anatomy
>
>
>> I learnt in voc. training about the difference between the diagnosis and
>> the problem. I have transferred that back to A&E and often find myself
>> asking the pt 'so what are you worried this might be?' or 'what do you
>> think is causing this?'
>
>Well, I think we're not too bad at this in A&E Fiona (better than the
>surgeons anyway). We know all our chest pains think that they've got heart
>disease, even if they don't come out and say so; the list goes on,
>headaches, skin rashes, you name it. I don't think we need three years'
>vocational training to make us understand this. And we spend our lives
>ruling out heart disease etc, we just don't do it in a touchy-feely way.
Now
>if you're telling me that the patient's chest pain is really a deep-seated
>manifestation of his marital disharmony or employment stress etc, then I
>admit it, I'm guilty, I don't go down that route in much detail, and I'm
>very impressed if you manage to in your emergency department.
>
>> In GP land a large proportion of my time was spent explaining to pts
'what
>> the specialist meant'. If you ever wondered why GPs are so didactic
about
>> discharge and clinic letters, its because often the pt comes home
without
>a
>> clue what was done or why, and what the plan is. Letters are vital so
the
>> GP can act as interpreter.
>
>I agree, patients don't absorb much from their first consultation, letters
>are very useful.
>
>> Obviously not all A&E pts need this approach, but I find it v useful,
>> especially with those pts where you're not 'connecting' or getting to
the
>> bottom of the problem.
>
>Yes, some patients come with clear anxiety related "somatisation"
problems.
>Again, it shouldn't take three years' VTS to detect this, and we should be
>able to point them in the right direction for further help. I just don't
>think it's my role to sort out their stress, although it's not beyond me
to
>be empathetic and supportive. Reassuring them fairly robustly is the first
>step in letting them know that their "physical" symptoms might actually be
>arising from a non-physical source.
>
>But GPs are often guilty of side-stepping these awkward areas as much as
>hospital consultants. I'm continually meeting patients who've been through
>the mill of MRIs and bodygrams, organised by their GP, in a vain effort to
>find the cause of their problems. In fairness I suspect that many patients
>drive their GPs this way. And many GPs are as guilty as others of using
>antibiotics, for example, to "terminate" a consultation. I don't believe
for
>a minute that GPs have a monopoly on "communicating" well with patients,
but
>perhaps I'm preaching to a convert...
>
>> It's not touchy-feely,it's a practical way of working that pays off.
>
>I suppose we're agreed then...
>
>Adrian
>
>> PS Adrian, were you a reg in Bedhampton once?
>
>Does that mean Bedford/Northampton?
>
>
>