2 May 2018

10 things we never got taught in medical school

General Practice RedHerring

The most important people in a practice are the receptionists

The ones who use their computer screens as metaphorical shields between you and the patients. 

Not only do receptionists welcome, triage, cater for and charge your patients, they will probably know more about them as individuals than you do. They are the first line of defence when things go awry and patients present wanting to vent their anger, frustration or fear. 

Receptionists who can manage to smile in the face of often unreasonable demands and atrocious toddler-like behaviour from adults have the power to determine whether the patients enter your consulting room issuing bile or greeting you with sweetness and light. All hail the receptionists.

How to deal with overfamiliar patients

A younger female work colleague was telling me how, during one consultation with an elderly male patient that was being recorded as part of her GP training, he had suddenly lunged at her for an entirely inappropriate embrace. She fortunately remembered diversionary Manhattan socialite tactics and did the old “dodge and block” manoeuvre. The gent being considerably shorter than her, ended up butting his skull into her right shoulder. Needless to say, she could not use that particular recording for her training.

Personally, I’ve found hugs and pats from female patients quite endearing. Male patients do not dare. In my experience, it is the older male relatives of the female patients who push the boundaries occasionally, coming in for the killer hug when you least expect it. Perhaps I should remember my colleague’s guerrilla avoidance tactic to use for next time. Or wear a bubble suit.

Backdated referrals. How to say no without offending absolutely everyone 

What to say when a patient asks that a referral be backdated a day, a week … a month. Recently, at our practice, a patient who we had not seen for 18 months, rang demanding a referral, backdated a week. Explanations as to why this was not possible did not appease her. The fact that she would be out of pocket by more than $300 was more important than the entitlement-loaded, illegal reality in her eyes. The flames of her ire were stoked by the fact that staff at the plastic surgeon’s rooms had encouraged her to get such a backdated referral. We won in the end and the patient attended to discuss it, complaining all the way.

Racism. It’s still there and it still grates 

It is not uncommon, patients not wanting to see the doctor with the foreign-sounding surname assuming they “could probably not speak English”.  Being Madame Dinosaur at our practice, patients are assured that I speak excellent English, but I still anticipate the silence when I have to ring someone previously unknown in the course of my work. I can feel the internal struggle at the other end for the person to marry the sound of my Aussie voice with my “non Aussie” surname.  I carry on regardless. One has to be professional even if the person one is dealing with is not.  Perhaps we should advise our medical students to counter racism with a charm offensive. Or food. All resistance crumbles in the face of moon cakes or Indian sweets.

Always know where the eucalyptus spray is kept

 Personal hygiene-challenged patients invariably leave the gift that keeps on giving when they exit the room. Medicare is a fee for service system, but many GP services don’t have an item number. So many of the services GPs provide do not attract a fee. Think of all those discussions with specialists, chasing of results, chats with concerned loved ones, ensuring your medical skills are up to date. 

Entitlement is catching 

Patients expect scripts to be written by phone request. They want referrals to be written without being seen. Results are asked to be conveyed by phone, text, Skype or email. Perhaps the increasing busyness of everyone’s lives is to blame. Perhaps the digitalisation of everything is at fault. However, patient convenience should not lead to the acceptance of medicolegal risk by us. See point three.

How digitalisation would invade the GP consultation 

As most services in life such as banking, communication and dating are being supplied via the internet, why not medical services? It is rarely necessary now for people to have to interact with actual human beings in order to obtain outcomes. Think self-serve supermarkets, ATMs, AirBNB … No need to talk to any person at all.

Screens rule

I once consulted with a young couple who were absolutely absorbed in their phones for the duration of the consultation. The end of every single sentence was punctuated with a glance and fiddle with their phones. It came as a bit of a shock to them that in order to obtain the requested medical termination of an unplanned pregnancy they would actually have interact in person with the suitable service.  I remember thinking it was perhaps somewhat surprising that there was a pregnancy at all as that would have involved actual physical contact.

In this increasingly digitalised and perhaps more physically remote world it must seem odd, even archaic to some patients that they are required to be physically present, in front of a doctor, in order to obtain treatment and advice. Strange too that physical examination is often still required for a diagnosis to be made. 

Perhaps it is this disappearance of human touch, both emotionally and physically from everyday life that explains why it seems I am seeing increasing numbers of elderly patients presenting with minor complaints. Sometimes I feel the real therapy I’m providing is the simple: “Hello. How are you?” with an interested smile, direct gaze and a sympathetic ear, while the rest of the world rushes by engrossed in the phones.

The law of the jungle applies in the carpark, even at the surgery

When it is the last parking spot available, the Hummer may fight a small Japanese hatch to the death. Who knows who will win? The mighty or the nimble? The desperate elderly lady in her Corolla may well nip in the parking spot before the hassled mother of three. Entertaining, but nerve-wracking, to watch at lunch time outside the tea room window.

Never underestimate the value of cake 

If everything else fails, there is always cake in the tearoom. Usually chocolate cake. Enough said.

Dr Dawn Oi is a GP in metropolitan Melbourne who hones her skills by writing referral letters all day