  Hearing and answering patients’
concerns
Information about medical
conditions, treatment options and medications rank
high among patients’ most common concerns. Limited
time during the consultation is often cited as a
reason GPs cannot provide all the information people
want. Strategies for making the best use of the time
available include the following:
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What patients
want to know about prescribed
medications:14
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When and how
to take medicine
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Unwanted
effects and what to do about
them
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Precautions
(such as possible effects on
driving)
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Problems
with alcohol or other drugs
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The name of
the medicine
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The purposes
of treatment
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What to do
if a dose is missed
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Organising the
practice so that an appropriately trained nurse can
provide the disease-specific information that
patients want.
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Making sure patients know that
pharmacists can provide expert advice on medications
and side effects. For those with complex medication
regimens, a home medicines review may enable people
to discuss their concerns in full. Allowing a person
to discuss their fears about medications, and gain
reassurance on what to expect, can lead to better
adherence.
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Giving patients information before the
consultation, e.g. disease-specific information or
a leaflet inviting them to list all their questions
to bring to the consultation.
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Collecting medical
history in advance, e.g. by the practice
Doctors are often concerned that
allowing patients to talk freely at the beginning of
the consultation will waste time. However, a UK
study found that, if uninterrupted, patients’
initial explanation of the reason for the visit
takes 1.5 minutes on average, and that 78% of people
will stop talking within 2 minutes of the beginning
of the consultation.13
Health professionals often
underestimate the psychological impact of disease by
focusing on the physical side, yet this medical
focus might differ from patient’s own concerns.
Case studies: ask about the
person’s own concerns
| Case 1. An elderly man with a
cardiovascular condition is referred by
his cardiologist to a cardiopulmonary
rehabilitation program. At the initial
assessment, he is asked, “If you could
fix one thing, what, if anything, would
that be?” The man replies, “My walking.
I can’t walk as far as I would like to.”
When asked what is limiting his ability
to walk, he replies without hesitation
that it is pain from osteoarthritis in
his knees.
On further discussion, it emerges
that arthritic pain as a reason for his
limited ability to walk was not noted by
the specialist cardiovascular services
he has been attending. He explains that,
“They never asked... And I was there for
my heart”. This man’s options for
managing his arthritis might include:
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medications for pain
relief (subject to precautions and
contraindications)
-
referral to a
community-based physiotherapist or
exercise physiologist (or working
with those at the cardiopulmonary
rehabilitation program)
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attendance at a
chronic disease self-management
program.
His GP, pharmacist,
physiotherapist and cardiologist would
all be involved in tailoring his care to
help him become more mobile. |
| Case 2. A 60-year-old man with
chronic heart failure and severe
symptoms visits his GP after discharge
from hospital. He brings the
instructions provided by the hospital,
which include weighing himself daily,
restricting fluid intake, restricting
salt and walking each day. He expresses
bewilderment with the number of new
obligations and says he has not done any
of these so far.
Rather than merely telling him to
follow the instructions, the GP explains
that these are important for staying
healthy, and asks, “Which of these
activities, if anything, do you think
you could start doing?” He opts for
weighing himself as the easiest
instruction to follow, and decides to
measure his current fluid intake to
learn whether it will be easy to meet
the suggested daily maximum.
At his next visit the GP asks
how he is managing, and discusses
various support services, such as a
self-management program, on offer in the
local region. Eventually the man finds
he is able to adhere reasonably well to
all the instructions, and explains he
had initially felt it was “all too
much”. |
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