Doctors are trained to take a patient history in under twelve minutes.
From the moment you walk into the consultation room, you have around seven hundred and twenty seconds to get whatever brought you there off your chest. It sounds a doddle, but believe me, it’s not.
At medical school, we have bells and buzzers and claxons to train us. We also have a wonderful selection of fake patients, with text book symptoms and an aversion to chit-chat, who make our lives an awful lot easier.
Real life patients aren’t quite so obliging.
Rather selfishly, most of them don’t read medical books – so their symptoms are vague and numerous and confusing. They also like to talk about the weather and their grandchildren and how the next door neighbour keeps them up all night, playing loud music and arguing with his wife. If patients were books, they would be an Agatha Christie novel – with a cast of thousands and a clue on every page. As a doctor, you have twelve minutes to read the book, find the clues and solve the murder mystery. It isn’t easy.
But it’s the ‘by the ways’ you have to watch out for.
These are the patients who seem to be a God send. They’re not interested in the weather and if they have over-achieving grandchildren or noisy neighbours, they like to keep it to themselves. These patients come to the surgery with a sore throat or a backache or a pulled muscle. Simple, straightforward and clean. Within eleven and a half minutes, they are tucked up in their coats, heading towards the exit with a prescription folded neatly in their pockets. Then, just as they are about to leave, when their fingers are actually resting on the door handle, they stop, look back over their shoulders and say:
“By the way …”
And then you realise that the sore throat was just a prologue. The real story hasn’t even started – and it’s the by the way you really should be reading, because it’s a:
By the way, I think I’ve found a lump in my breast
By the way, I’ve been getting a bit of chest pain
By the way, I’ve got a bottle full of paracetamol in my bedside drawer and if someone doesn’t help me, I’m frightened that I’m going to take the whole lot.
These are the stories we need to listen to.
An elderly lady once attended a GP surgery to talk about her blood results. She was accompanied by her husband, both in their best clothes – because to that generation, going to see their doctor is an occasion for which one is supposed to dress up. They shuffled into the consultation room, all coats and walking sticks, and took a tantalising amount of time to settle their old bones into the plastic chairs and find somewhere for all their possessions. Three of their twelve minutes had already passed. At first, I wondered who the patient was. And then I realised they both were. They were a team. The doctor spent a good seven minutes, talking about the lady’s renal function and her haemoglobin and how it was normal for someone of her generation and how he would see her again in three months’ time. And she replied:
We all looked at her curiously and she continued:
“I can’t stand at the sink anymore to peel the potatoes – I feel too old and tired.”
So the doctor smiled (in the way that doctors sometimes smile at patients) and he spent a further two minutes saying that everything was normal and to make an appointment for three months’ time on her way out. The claxon had sounded. The twelve minutes were up. And so the elderly couple disappeared from the consultation room, with their walking sticks and their untold stories, and a fragment of their independence was left behind on the plastic chairs.
When I was growing up, I always went to my father with problems. He was the kindest, most patient, most wonderful man I will ever know and he always knew how to fix things – from broken hairdryers to broken hearts. Whenever I presented him with my latest drama, he would tap his pipe out on the fire grate, lean back in his chair and always say the same thing:
“What every problem needs first, more than anything else, is a really good coat of looking at”
And he was right. But in a society where we all have internal buzzers and bells and claxons, giving something a really good coat of looking at isn’t usually an option we can take. As A&E patients change from green to amber to red and GP surgeries fill with people who are anything but patient, those twelve minutes become increasingly precious. We don’t have time to read the whole book. This is how the cancer and the overdose and the heart attack are missed and when they are, we all start shouting and screaming and blaming each other.
In the land of twelve minutes, doctors really have to be fast readers, because there are some stories out there which definitely need to be heard.