Dr Punam Krishan: Here's how you can get the best out of you GP appointment

I often get asked in interviews why patients need to tell the receptionist the reason for their call. In fact, frontline admin staff in surgeries unfairly get a poor reputation and it’s important people understand why they do what they do.

From the moment the practice opens in the morning, the phones in every surgery don’t stop ringing.

I tried to sit in our practice reception one afternoon to do my paperwork and my ears were ringing for hours later - I really don’t know how they do it. They are tasked by us, the GPs, to ask patients what they perceive the problem to be.

This is to allow them to put the patient onto the right doctor or allied healthcare professional’s list for a call back or appointment. Primary care is made up of a huge team which includes many experts so sometimes a problem might be more suited to the practice nurse, the advanced nurse practitioner or the pharmacist and other times it might be the GP.

The information you provide allows them to gauge your needs. The second important reason we ask them to identify the problem is to allow us to prioritise in terms of time. When I look down the column on my computer screen of patients I need to call back, I see the problems next to the names and I can immediately tell who needs an urgent phone call eg. suspected stroke or chest pain versus someone who I can call back a little later eg. discoloured toenail.

That initial phone conversation with the receptionist is confidential and is also the ideal time to let them know if you need an interpreter (if English isn’t your first language), if you’d prefer a male/female GP in case it’s for an intimate problem requiring examination or whether you need a double appointment because you have a few issues to discuss. So next time you get asked about why you want to see the doctor, know that it’s because it helps facilitate your appointment and not because they’re nosey!

Practices across Scotland are under immense pressure just now and I can empathise with people who complain about how long it takes to get through to actually speak to anyone. Whilst I empathise with the frustrations, I also say that being on the other side of that door is really tough right now. It’s always worth checking your practice website therefore to see if they have an online booking system which might make it a more efficient process.

The model in most practices involves telephone or video consultations where a history would be taken to understand what the problem could be. In cases where a clinical examination would not be needed, the patient can be managed remotely however if after chatting, it’s felt that the patient needs to be physically assessed, they are invited down to the surgery in a safe and controlled way for this.

The reasons for this are because COVID is still very much a threat as cases continue to rise and we want to ensure that patients and frontline workers are kept as safe as possible. It’s important to understand that all patients coming into the practice will be vulnerable in some way and therefore potentially exposing them to other sick people, who may or may not have Covid, will cause harm.

In our practice we’ve got separate consultation rooms which are cleaned thoroughly in between patients. We have rooms designated for potential Covid patients and rooms for non-Covid patients. I’m sure most people will agree that with the current situation, where there are high transmission rates, nobody would want to put themselves in close proximity to other people. In this scenario you will be asked to attend the time of your appointment, wear a face mask, respect social distancing and be directed swiftly out of the practice after your examination. This is not how we previously practised medicine and I do hope that this will not be for much longer, but this is where we are at just now.

GPs typically have between 10 to 12 minutes per patient. On an average day, we GPs see between 30 to 40 patients. Time is precious. So there are things you can do in order to get the most out of your appointment which will also help your GP. Before your speak to your doctor, write down on a piece of paper the things you want advice on. If it’s more than one medical issue, prioritise them from most urgent or important to least urgent. This means that your GP can address the most pressing problem first. A useful acronym that doctors use is called ICE which stands for ideas, concerns and expectations. It’s helpful for patients to have a think of these before speaking to the doctor and communicate them. What do you think is going on? What are you worried it could be? What would you like to happen at the end of your appointment? The days of “doctor knows best” are gone. Medical appointments are a collaborative effort where we rely on our patients to tell us everything in order to allow us to come to a joint management plan. You have the right to ask for a double appointment, a chaperone, an interpreter and can also seek a second opinion if unhappy.

Ultimately our job is to take care of our patients. We have been doing this throughout the pandemic despite the challenges and we will continue to do so even though we are facing huge amounts of unfair and misinformed criticisms. The hospital wait times for clinics and operations are exponentially rising which is putting extra pressure on GPs.

The backlog from other reduced services coupled with the mental health and long Covid cases are putting strain on an already stretched service. We are providing acute care as well as caring for those with chronic disease. Until such times that we can start getting our patients seen and managed in their respective hospital appointments, we start seeing the pandemic easing and we get more support to help with the rising doctor shortages, we will struggle. For now however, we can only make the best of a difficult situation and help one another - both healthcare workers and patients - to stay in as good health as possible.