Business patients

Why oh why do I continue to have hope about the England cricket team? After the abject defeat in Adelaide to go 2-0 down, why should there be any hope of a comeback to retain the Ashes? Yesterday was a fine start yet again by England, but this morning when I woke up it was a familiar story, England all out for 215 runs, 29 less than Australia. Let's just get the defeat over and done with and kill all remaining hope.

Being Friday means I'm absolutely exhausted. I finally managed to read the e-book I mentioned in a previous blog and intended to summarise it today, but I'm so tired that I think I'll leave it to another day, probably Monday, should be suitably refreshed by then. I'm leaving for my third holiday of the year next Wednesday, this time to India to meet my grandparents. I'll also be visiting my wife's family in northern India which will inshallah provide me with the chance to visit the Taj Mahal.

It will be difficult to blog while I'm away, but I should have access to my email, so if some of you would like to blog then please email me and I will post the blogs whilst I'm away. Obviously being Christmas and New Year you're all going to be busy, so I doubt I'll get any blogs, but it's still polite to ask. Hopefully once I come back in the New Year, this blog will continue to develop during the last month of my job in the GP surgery before the dreaded A&E starts. When I start A&E it will be next to impossible to update this blog on a daily basis, I'll be lucky if I can post something once a week. You all will have to help and chip in with some blogs. At least this way this becomes a forum for everyone to air their thoughts on pretty much anything and surely you would be interested in that?

Moving on to today's blog, there is a certain type of patient who I like to call 'business patients'. These patients turn up, go through their problems and then expect very specific treatments for them. They are not willing to listen to any advice and often refuse to negotiate. They are often middle-class, white males, working in some sort of finance/marketing/business field, with high-pressure jobs. They treat their appointments with the doctor as a business meeting. In order for them to win, someone else has to lose and which equates to the doctor complying with their demands.

I've meet quite a few of these patients and they are all very similar. Part of my training requires me to video my consultations with patients (with their prior permission of course) which I can then review with my GP trainer and go through what went well and what I could improve. We viewed a consultation of mine with a 'business patient' and initially I couldn't work out why the consultation was going so poorly. I was doing all the usual things, asking the touchy-feely open ended questions and the guy was simply not cooperating.

Instead of focusing on what I was doing wrong we switched our attention to the patient. From his body language you could tell that he was not going to negotiate. He sat on the chair, legs crossed, arms folded and maintained that position throughout the consultation. He did not move from that position. Often patients interact, they move their hands etc whilst they try to explain their problems, but this guy only moved his hand once, to adjust his tie.

Having recently moved back to the area he came asking for more sleeping tablets which he had been taking at his previous surgery. The tablets he was taking had no effect on sleep whatsoever, but he was refusing to listen to my advice and insisted on the tablets. Eventually he got what he wanted. The tablets were pretty harmless, but he had developed a psychological addiction to them to help him sleep.

He left the consultation having 'won' the meeting with the doctor. However, in the long-term he will lose, because if he maintains that attitude, if more serious problems develop with his health and he refuses to listen to advice, things could get worse. Speaking to my GP trainer, he spoke about how difficult the 'business patients' are and often they'll only learn through their mistakes and there's not much we can do about it.

You may think in this case, I should've refused his request for sleeping tablets, but it's not as simple as that. He is psychologically addicted to the tablets and in order to stop taking them he would need some counseling to help him, but there is no way he would accept such a plan and so the best option was to continue with the tablets and hope that in his repeat visits eventually something will click and he will realise he should stop taking them. At the end of the day it has to come from the patient.

To finish off with, there was an interesting study done about the 'business patient' by a GP not so long ago. In most consultation rooms, the GP sits behind a desk with his/her computer and the patient sits to the side of the desk so that when they are conversing the GP can switch to the side and focus on the patient without there being a desk between them (at least that's how a good consulting room should be setup). One GP set up his room with a chair directly opposite the desk and one to the side of the desk, allowing patients to choose which chair to sit on. 80% of patients who sat on the chair opposite the desk where middle-aged, white males, mainly with high-profile, stressful jobs. They liked the security of having a desk between the doctor and the patient, more meeting-like. I thought that was quite interesting.

Well that pretty much ends my Friday blog which has officially become the medical profession blog! Boring for some I admit, but not many people tend to read the blog on Friday, so I guess it shouldn't be a problem. What type of patient are you?

Take care all,
Thoughts just flow, when do they have to make sense?