Difficult Patients and Managing The Consultation

Difficult Patients and Managing The Consultation

Dr Deen Mirza, founder of Better Doctor, comments: “Few outside our profession can understand the feeling of panic we experience when we are 20–30 minutes behind (or more) in our appointments. The stress generated is disproportional to the actual harm caused to patients. Managing the consultation time is probably one of the key flash points in the day. This will be a significant factor in reducing overall stress.!

Deen has written four books which are available on Amazon: a three part series on ‘How To Consult Efficiently’ and another on managing difficult patients with unreasonable demands (the FRAYED consultation model). He also runs popular one-day time management courses for doctors.

‘While I’m Here Doctor’ and Long Problem Lists

Below are some tried and tested useful phrases to help you manage the consultation:

  • “I think that’s a problem we’ll have to leave for another time.”
  • “Gosh it sounds like there’s a lot going on here, will you come back and see me again next week.”
  • “I don’t think I can possibly do that problem justice squeezing it in at the end of today’s consult.” etc
  • “So we can plan our time – is that all we need to cover today?/ is there anything else you were hoping to cover?”
  • “Sadly as we only have eight minutes time together we need to be realistic about what is safely manageable, what would you like to cover today and what would you like me to arrange for you to have another appointment for.”
  • “I am going to leave that there, we have so much to explore, now let’s book you in for more time with me.”
  • “Unfortunately we are now in the next patient’s appointment time, let me arrange for you to have more time to sort this out for you…’ This approach allows the patient to realise that their time is up and hopefully allows the impact of running late on other patients to be thought about.”

The ‘Heartsink’ Patient

David Rainham talks about strategies to manage these patients in his book The Stress of Medicine, produced for the NHS Pratitioner health programme.

He describes 20% of the patients causing 80% of the stress and gives a number of suggestions for managing them:

  • Set ground rules for frequency and length of visits. Consider a longer appointment that will allow you to really listen to the patient and identify their underlying worries.
  • Recognise the feelings these patients elicit in you – be that anger, frustration, resentment, inadequacy etc
  • Use ‘metatalk’ with useful phrases such as ‘I’m finding it difficult to help you’; ‘What can we do to work better together on this problem?’; ‘what changes have you had to make as a result of your symptoms?’ and ‘That’s great that you are doing so well in managing your condition’. This encourages ongoing self responsibility and self care, helps focus on action and have a greater sense of control and responsibility. ‘I can see that these symptoms are very distressing to you but thankfully there does not seem to be any sign of serious illness’.

Time Saving Apps, Tools and Resources

  • Which has a useful article that could be used as the basis for a patient leaflet or to share on your surgeries website.
  • Itamus.com, a site founded by two UK GPs, Richard Thomas and Colin Coulthard, is an indexed, searchable and maintained repository of information that is quickly accessible to the front line primary care physician. There are links to hundreds of useful tools and resources and apps, arranged according to speciality as well as local useful phone numbers.

Value Your Time

Do you have jobs or tasks that are time consuming and not enjoyable?

For example do you hate gardening or cleaning? Calculate how much these jobs are costing you to do at your current hourly earnings, it is likely that it will be much more cost effective for you to pay to delegate these tasks, thereby freeing your time to spend on the things that bring joy to your life.

Work Out Your Goals

  • Identifying your personal and professional goals – short, medium and long term – helps underpin and drive your time management and aids planning and prioritising your workload and tasks. This is a useful guide.
  • Set your goals and make them happen
  • GP-S coaching and mentoring service is free to all GPs locally and can help you do just this.

Work Life Balance

Time management helps to make room for life – see section on work life balance – coming soon