A Word with the DOCTOR
by Dr John Winsor
The Sunday Times of Malta
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What to tell the doctor

DO YOU get tongue-tied at the doctor's? Do you dry up when you enter the consulting room? What do you say when you sit down by the doctor's desk?

Doctors have a similar problem: what to say to patients. To start the consultation with "How are you?" is just no use. Whenever I've tried that opening gambit, "very well, thank you" has been the instant response - followed by a pause. Then an embarrassed "Well no, I wouldn't be here if I was".

"What is the matter with you?" is another non-starter from the doctor's point of view. It brings forth the reply: "That's what I wanted you to tell me!" or "You're the doctor, not me. I don't know what is wrong."

Over the years, I've opted for a greeting such as, "Good morning, Mr Smith. What can I do for you?" Even this goes wrong sometimes, but at least it leads to fewer hiccups getting the consultative ball going backwards and forwards, from patient to doctor.

Many times, just as I think I've successfully sorted out their problem, my patient produces another one, like a magician bringing rabbits out of a hat, but these are different animals each time! At the rate medical matters can be solved, only a couple of them can be discussed before the consultation runs out of time; and I'm conscious that there are others waiting their turn, and getting worked up about their chat with the doctor.

Dilemma. What to do now? If I curtail the consultation abruptly, my patient will feel that they have had a raw deal, and that the doctor doesn't care, or isn't interested.

So, be honest with your doctor. Tell him you've got more than one worry, and ask if he can deal with them at that time. If not, offer to come back again when he has more time, and could give you a double appointment.

That's how I often get over this consultation hurdle - by sizing up the problems presented, tackling the most important, and then suggesting that the others can be dealt with in depth later.

Time also needs to be set aside to find out whether the advice has been understood. It has been calculated that a patient only remembers a third of what has been said in the surgery, and there's no knowing if it's the important third either. If you don't understand something, say so rather than get the wrong end of the stick, and start worrying over nothing.

Lastly, there is the door-knob situation. The patient talks about a seemingly minor problem. The doctor deals with it, and the consultation ends. The patient reaches the door and turns, saying "Oh, by the way, doctor - I've got a discharge." This starts the consultation all over again.

Don't be shy. Get talking about what is worrying you most as soon as you've sat down and said "Good morning". Try not to get embarrassed; doctors are trained to talk about delicate matters. Don't be afraid to voice your fears. After you've let them out they won't seem half so bad, and you'll have got the best out of your chat in the surgery.