Ten minutes

‘I’ve only come in for a quick medical review doc, receptionist said I had to, won’t take long duck..’ Mary muttered as she made her entrance.

I introduced Ben to her, our final year medical student. She immediately embraced Ben’s presence, saying how nice it was for her to meet future doctors, and ah what a handsome lad he was!

‘Ben is going to record my consultation skills today Mary, and also whether I run to time’ I tried to explain, to which she responded with a bemused smile.

I wondered how I could demonstrate to Ben the different stages of a well-conducted GP consultation - initiating the consultation, establishing rapport with the patient, and listening actively. Identifying goals to be achieved not only from the patient's point of view, but also from the GPs, negotiating towards the identified goals,  summarising to effectively use time, planning management together, bringing consultation to a close with safety netting etc - all within the ten minute time frame we have in General Practice. Or perhaps fifteen minutes, as I am often fortunate to have.

‘As it is your medication review Mary, do you have any questions you would like to ask about your treatment?’

‘No doc’ she said. ‘I am taking everything you prescribe, and I am putting the new eye drops in my right eye, but they told me at the hospital that my blood pressure was up, and to ask you to check.’

From scanning her computer records I realized Mary had had right cataract extraction only two days previously, and her right eye was still very red, and watery. Hypertension with ischaemic heart disease were longstanding complaints, for which she took five different agents including lipid lowering medication.

Today’s BP was borderline. I decided to show Mary her previous trends in her BP control, and Ben could also see that really prior to going in for her recent eye surgery, Mary’s BP had been well controlled.

‘Could it be that it was the worry over going in for the operation - and being in hospital that shot up my blood pressure?’ Mary spontaneously asked. So we agreed to wait a bit, and recheck her BP perhaps in 2 weeks.

That left Exemestane tablets - and Ben said he was unfamiliar with them. So Mary promptly proceeded to tell him all about her breast cancer, how she had first ‘fount out’ the lump, to rapidly having her lumpectomy, and how she was still ‘beautiful’, and that these tablets kept ‘it away’, and that a recent mammogram was all clear, thanks to the hospital champions!

Finally I thought we had finished, when Mary, like many of our well prepared patients asked ‘what about my blood tests doctor? I usually remember them this time of the year, along with my tablet review!’

Well, she was indeed due her routine annual fasting blood tests, weight/urinalysis, etc so we gave her an appointment to see the health care assistant who would also check her BP, and explained that she could discuss the results by telephone consultation.

‘Oh no!’ she said. ‘I’d sooner come in and see you myself duck!’