The Corridor of consultations – have you closed all the doors?

A consultation is like opening a door on a person’s life

Check the door is closed safely after you leave a consultation

A good day is when all doors are closed safely and each person is helped a bit

Doctors can’t deal with every issue but they can acknowledge each one.  In the NHS service in the UK there are seven minutes within each ten minute appointment to acknowledge each issue and tackle the agree priority

 

A consultation is like opening a door on a person’s life

A GP surgery, of say sixteen patients, is like walking down an imaginery corridor and entering a door every few steps. Each open door allows a doctor to enter a consultation onto a part of one person’s life. Behind each door is a room and you can explore many shelves holding information about that person’s life.

The aim is to find the main issues for that person and help tidy their shelves a bit before leaving the room. If all goes well you can then close each door behind you with some of the issues partly resolved and none of the shelves about the fall down in chaos.

Check the door is closed safely after you leave a consultation

Check the door is closed safely after you leave a consultation. The point about this analogy is that a GP will have an awareness of when they have not made the shelves safe. Of when there is an outstanding issue that needs addressing at the end of the surgery. An awareness of when they need to return to close the door more carefully. Possibly by thinking about the consultation in more depth, or by a phone call or even meeting the patient again There are things that stop a GP returning to outstanding issues. Time is the biggest pressure. A long, packed, day stretches ahead with some sixty more consultations and a deadline to get home at the end. The emotional pressure of each consultation can overshadow the day and prevent the GP thinking clearly. The sheer volume of issues can also overwhelm. Some GPs react to the daily impact of time, emotions and volume by ignoring issues consciously or subconsciously.

This awareness may only be a sensation that all the issues have not been covered. Sometimes it can be described as a gut instinct. The patient may have seemed unsure, dissatisfied, or even angry. It is worth tuning into this gut instinct to raise your awareness of when a door is still open. Perhaps, writing on the computer, or a notepad, that you need to think about things more carefully later in the day. Doctors can’t deal with every issue but they can acknowledge each one It is impossible to deal with all issues and it a patients responsibility to deal with the issues not the doctors (we are all patients). But a doctor needs an awareness of all the issues in that consultation so they can determine which are most important. They may have to be put back on the shelf untouched for another time, but at least they should be acknowledged and recorded. And we are not talking about every single issue in a person’s life. It is just the issues that each person, and the doctor brings to the consultation on that day. It may be just one, usually it is around five, occasionally if can be as many as ten. It is quicker to deal with one issue and close the door. It is harder to handle ten issues successfully and stop the door bursting open, but that is a doctors role.

A good day is when all doors are closed safely and each person is helped a bit

A good day for a doctor, and their patients, is when the doors are all safely closed afterwards Even better if all the issues on the shelves have been addressed in some way. A difficult day for a doctor is when the doors are all still all open, shelves groaning and unsafe. The doctor has to go back and recheck each consultation tie up loose ends and possibly repeat the consultations again.