Questions and Answers / GP Doctor Consultations #Guest Post


I would like to recommend a brilliant site called GP Doctor ( http://www.thegpdoc.com )who have kindly allowed me to share with you one of their posts. As a Receptionist you will all be very familiar with many of the questions below, and maybe even some that you have not come across or had the answer before.

I hope you enjoy it.

Guest Post

GP Doctor Consultations – Question and Answer Session
BY GP DOCTOR · MARCH 7, 2015

GP Doctor Consultation Q&A
Patients often have many questions about the GP Doctor consultation process and all of the questions asked below are genuine questions posed by patients. Hopefully it addresses some misconceptions about the GP consultation.

How long does my GP Doctor have to see me? It seems very rushed.

10 minutes. Realistically 7 minutes as the 10 minutes includes calling the patient to the consultation room, referring if required, prescribing and writing our notes (which is very important for your records so there is an accurate picture of your medical history which helps in future consultations).

Why not offer longer appointments?

There is already a recruitment crisis in GP and currently there are not enough GPs in the UK. If we offered longer appointment times, fewer patients would be seen in the day, contributing to longer waiting times for appointments.

Why have I been waiting to be seen? My appointment was 15 minutes ago.

The patient before you may have been very unwell with multiple complicated conditions requiring more time. Furthermore your GP may be running a little late if they had to discuss a patient with hospital specialists or had to deal with other emergency situations or telephone calls. It could also be simply that the patients seen before you presented with multiple issues that they wished resolved.

Is your time more important than mine that I have been waiting so long?

No GP feels their time is more valuable than the patient’s time. We do try to keep to time. However situations out with our control contribute to sometimes running late as also mentioned above.

I am only 5 minutes late. Surely this is not an issue?

Bear in mind that you may only feel it is 5 minutes. However if lots of patients attend late for their appointment your GP is then automatically running late for patients later in the day.

What if I have a list of things?

You may have a list. But if you tell me this at the start of the consultation, I may be better able to help you. Mentioning this at the last minute makes it more difficult as we may have spent a large proportion of time on only 1 issue.

I don’t come to the GP often. Surely I am entitled to have longer or discuss all my issues?

We try to discuss and manage as much as we can in 1 consultation. However bear in mind that there are other people waiting so it doesn’t mean I can solve all your problems in 1 appointment especially if they are more routine matters and you have, for example, 5 things you want addressed.

Years ago my GP had time to have some social chit chat. Why not now?

It’s not that your GP is not interested but is pushed for time and the next patient will already be waiting to be seen. We feel it is important to actively engage with patients and firmly believe that part of this is building a good doctor-patient relationship. Unfortunately due to time constraints we may not be able to talk to you for as long as we would like.

The waiting room only has a few patients in it. Surely the GP must not be very busy?

This shows an effective appointment system that is working well and not large queues still waiting to be seen.

Why can’t my GP see patients constantly in the whole day?

See the other related post “GP Myths – Appointments” which answers this question.

Why do you not know all my medical history when I come to see you?

It may be the first time you have met the doctor and he/she will not have had time before seeing you to go through all of your notes in any great detail. In addition it is better for us to ask you to get accurate information rather than just rely on the notes.

Have you read my notes before seeing me?

With anywhere between 5,000 – 15,000 patients we can’t know everything about your medical history off by heart. We probably haven’t had a chance to look at your notes in great detail before seeing you. However if we need to know more we can ask you or look at your medical notes during the consultation.

The GP called me back today. Why is he/she asking me what I wish to discuss?

We cannot assume why you are here. You may be attending to discuss something else and that’s why even if we have asked you to come back we ask at the beginning the reason for your attendance.

My GP is looking at the computer during the consultation. I’m sure he/she is using Google to diagnose me?

No we are not diagnosing you using our computer. We need to look at the computer for your medical notes. We also may use the computer to check doses and local guidelines regarding drug prescriptions.

Why is my GP asking me what is wrong? Doesn’t he/she know? I just want a diagnosis.

If your GP asks something similar to “What do you think may be causing your symptoms?”. It isn’t because he/she wants you to self-diagnose. You may have thoughts about what you feel may be causing your symptoms or condition. Everyone has thoughts about what may be wrong. If we know this we can answer questions you may have regarding this or to address misconceptions you may have. Furthermore it also helps us identify how much detail we need to give as you may already know a great deal about your symptoms/condition. If we don’t know what you think may be causing your symptoms you may leave the consultation feeling that your questions haven’t been answered or that you are adamant it is something else. We don’t want you to leave thinking “My GP told me I have X condition. I think I have Y condition”.

Why does my GP ask so many questions rather than just tell me what is wrong?

Most diagnosis by all doctors is reached from information gathered from the patient. Therefore it is important that we gather as much relevant information as necessary to do this. Investigations can be helpful to diagnose but remember most diagnosis is reached from talking to you. In addition we do not have access to immediate scans and blood results.

My GP looks at a book for drug doses. Why?

We can’t remember all drugs doses and sometimes have to look these up. It’s better to be accurate if we are unsure. In addition there are multiple doses for children depending on their age.

I have been asked to come back for a follow up. Should I?

Yes. If your GP feels you should attend again to review your condition it is important to do this. This will also prevent asking for an emergency appointment in case things haven’t improved. If your GP has asked that you come back in a few weeks he/she may also want to see how your condition is evolving or discuss blood results that you have yet to have done.

I came back a few weeks later and another GP said I had something else? Was I misdiagnosed?

Not necessarily. Symptoms evolve. We can only base our diagnosis based on what you present with at the time of seeing us. Symptoms and conditions evolve over time.

I came about my sore foot. Why am I having my BP taken or asked about smoking or if I am up to date with my smears?

We may try to opportunistically help with health promotion. You may not attend to see us often and it may be the only chance we get to discuss these areas which can help improve your health.

Bradford CCG’s fund GP Receptionist Training


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Bradford clinical leaders are funding customer care training for GP Receptionists to help improve patients’ experiences at surgeries.

They are responding to patients concerns by looking at ways to improve access to local GP services and are going to hold training sessions for practices in the Bradford area to help staff make each patient feel valued and at ease.

I have included links regarding this topic.

http://www.dailymail.co.uk/news/article-2946645/Stop-grumpy-patients-Training-doctors-receptionists.html

http://www.bbc.com/news/uk-england-leeds-31420045

http://www.bradforddistrictsccg.nhs.uk/news/bradford-ccgs-fund-gp-receptionists-training-to-improve-patients-experience-of-primary-care/

I am very passionate about good patient/customer care, and feel very strongly that Receptionists need the correct support in the way of training. I am saddened by the hard times that Receptionists often get and I do appreciate that there are some that perhaps come under the category of not been the most helpful, but in my experience there are so many good Receptionists out there doing an excellent job.

I am a firm believer that a good trained member of staff is more confident, and therefore able to deal with the many different situations that they are faced with in Reception on a daily basis.

Well done to Bradford CCG for investing in this training programme which will benefit patients, staff and Practices throughout the region.

Lets hope that other CCG’s follow this great example.

Beyond Courage #Guest Blog


No parent should outlive their child. The pain of loss and grief is too much to comprehend. Life taken as such an early age – this is the most heart-moving stories that I have written since starting my blog.

I want to share with you the importance of patient care; it not only extends to the patient, but to family members of the patient. Care good or bad can often be left with such an impact in someones life.

My cousin Chris her husband and their only child Andrew moved to Australia in 1989.

Andrew was diagnosed with Chondroblastic Osteosarcoma on his 21st Birthday after a pathological fracture. For 15 gruelling months he underwent 10 operations including major surgeries to initially replace his cancerous left fractured femur and knee-joint. He went through 16 round of chemotherapy, ending with the amputation of his left hip and leg and ultimately his young life at 22 years and 3 months.

Chris has kindly offer to write a guest blog highlighting some of the patient care that has had in some way had an impact on her – to share how vitally important patient care from the Reception staff through to the nursing staff.

Chris is in the process of writing a blog on this subject so dear to her heart and the link is:

http://www.beyondcouragelancashire.com

and she has also written a book on her journey with Andrew through Chondroblastic Osteosarcoma “Beyond Courage”

The book insightful and greatly moving, “Beyond Courage by Chris Lancashire” does not only let readers experience the admirable courage of a man whose prime of life came to a sudden halt, but it also sheds more light into osteosarcoma and its intricacies.

Thank you Chris for sharing your story with us in the hope that everyone ultimately receives the care that they deserve.

Guest Blog : Beyond Courage

by Chris Lancashire

Thank you for inviting me to your Blog.

My background is in health, and I have worked both in the private and public sectors, in England and Australia over a period of 35 years.

On a personal note, I am a mother who went through the health system, when my son Andrew was diagnosed with Chondroblastic Osteosarcoma, a rare bone cancer, predominantly of the young teenagers and young adult. He passed away in November 2008 at the age of 22 years old.

I feel qualified to say, that the health systems are set up to help, assist and care for the vulnerable, fragile and sick patients that seeks care. Most of the time, the health system does well. Other times, these very systems that are placed to provide these care, failed to deliver these care, to the patients.

It is not the systems, that we constantly have to remind ourselves. The healthcare system is run by people. It is the very people in the healthcare system that actually provides that care.

Travelling with my son on his cancer journey is the toughest role firstly as a mother, and as a health professional. Protecting and caring for him in any way possible is the ultimate. I knew he was confident with the multidisciplinary health care team looking after him. More so, he knew I was able to be there for him, with my background as well as being his mother.

Somehow along this already difficult journey, there were situations and experiences that would make this journey even more difficult. It is at times like these that we always look at the human resources and education within the healthcare systems that can only be improved.

There were several nursing and reception issues, and experiences that also made me reflect on why these staffs was there. I would like to share here with one of this experience.

When Andrew broke his left femur, his contact with the first hospital, was an unforgettable and unpleasant experience. This was on a Saturday, the same day when he broke his left femur. Although Andrew was there for 36 hours, and pending him being transferred to the second hospital, where his orthopaedic surgeon was, it was a long 36 hours. He was in extreme pain, due to his fractured femur, which now had looked like a hugh balloon on his left thigh. Andrew was very drowsy due to the massive morphine injections given to him, very frequently according to the nurse. His left thigh (where the fracture was) was propped up with rolled up pillows underneath, to give the left thigh support. He was bed ridden, on his back and not able to move much, without the fractured ends of his femur grinding together.

Being extremely drowsy, due to the opiates, he was not taking much in the way of diet. His body temperature was up, so he had a high fever. They were no other forms of fluids ordered.

I visited over the Sunday with his dad, and we didn’t see any doctor to explain anything. We knew he was to be transferred when a bed was available at the 2nd hospital. However there was no treatment plan while Andrew was there, as such. When asked, the nurse who came in infrequently told us Andrew was having his frequent morphine injections and waiting transfer.

On Monday, I visited Andrew early around 0800 hrs, in case there was news of his transfer, so that I could organise and packed some of his things. I checked with the receptionist at the nurses’ station, to see whether I could visit him, giving her his full name. She checked on her computer and said, ‘Yes, you can visit. The nurse is with him at the moment, assisting him in the shower.’ My heart started racing, thinking that was not possible. He could not even move. He was almost semi-conscious most times due to the effect of pain relief. I rushed into his room. I saw him lying flat on his back, alone. He was drowsy, but awake and in pain. He had already pressed his call bell, nearly 20 minutes before. Andrew liked his wristwatch on him most times, so he knew it was a while since his call. His breakfast had arrived, and it was placed on his bed table, which was at the foot end of his bed. I saw my son, helpless and in pain. He couldn’t even reach his bed table to get any drink or his breakfast. I had to go and find the nurse looking after him to let her know of Andrew’s pain.

The receptionist made no effort to apologise. By this time, I had made this experience of my son and I known to the nurse in charge that morning.

Patients have a right to receive care, nursing, medical and all forms of holistic care whether in hospitals, care facilities or home. Even the most basic care such as human empathy, compassion and kindness. Too often, we blame these healthcare organisations and facilities for not meeting these fundamental, basic human needs and right for care. We sometimes forget that these very facilities are staffed by people who deliver care at the frontline. For me, I believe, it needs to come from the individual, and everyone that has been given the privileged to be in that position. It is a very humbling position to be, not a position of power or ignorance.

Thank you for allowing me to tell my story.

In honour of my beautiful son Andrew, I have written my book called Beyond Courage by Chris Lancashire. All proceeds from the sale of the books go towards medical research into finding an improvement treatment, and cure for Osteosarcoma. Please feel free to check out the book, and website of the same name.

 

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In memory of Andrew Lancashire 

Infection Control in Reception


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Infection control starts the minute someone walks through the front door of your organisation.

It is important that sufficient information, training and support is put in place for all Receptionists and frontline staff to help them deal with the various daily challenges involving infection control.

Staff need to be reassured that the job that they are doing is done well and that they continue to be supported and motivated to provide a good service to your patients.

Staff should be adequately trained to deal with infection control and this training should include cleaners and all Reception staff.

Training

Infection control training should take place on a regular basis for all staff. Do you include cleaners in your training? Some practices have outside agencies; if so, do they hold a copy of your Infection Control Policy?

Does your organisation have a designated person for Infection Control? Is all your staff aware of whom this is?

Do you have a report policy in place for identifying any risks of infection control – Reception should be included in this policy and know whom they should report to.

The Infection Control lead person should carry out the following:

  • Help to motivate colleagues to improve good practice
  • Improve local implementation of infection control policies
  • Ensure that infection control audits are undertaken
  • Assist in the training of colleagues
  • Help identify any Infection Control issues within your organisation and work to resolve these.
  • Act as a role model within your organisation.
  • Ensure that Infection Control protocols are reviewed and updated on a regular basis – or delegate to an appropriate person.

Hand Washing Procedures – Public and Staff Areas

Wash hand basins with suitable taps, liquid soap dispensers, alcohol rubs, paper towels and waste bins are essential items for all clinical care areas.

Whilst it is normally the responsibility of the cleaner to ensure that all of these areas are kept well stocked, some things might run out during the day. Therefore it is important that staff are made aware that these might need to be replenished throughout the day.

I have lost count of the number of times I recently have gone into hospitals and surgeries finding empty alcohol rubs, and toilets without toilet tissue or paper hand towels. It simply is not good enough.

Staff Immunisation Protection

Your Reception staff will be dealing with many Infection Control issues on a daily basis.

They will be receiving samples at the desk from patients. They will be dealing with patients that could possible come into your organisation with an infectious rash and could be asked to help with spillage. It therefore is important to include them in protection against Hepatitis B.

You should also offer your staff annual influenza immunisation.

Any immunisations given to your staff should be recorded. I would recommend that you record those that declined to have any immunisations.

Handling Specimens

Samples should come in a sealed container. I have had experience where many samples have come in all different shape and forms including:

  • A faeces sample in a child’s bucket
  • A faeces sample inside a plastic sandwich bag.
  • A urine sample inside a Tupperware container – the patient in fact asked when we had tested the urine could she have the container back as it was one of her “best containers”
  • A urine sample inside an empty perfume bottle.

These of course are not acceptable, for one it is not acceptable to expect the Receptionist (or nurse) to deal with this, and of course it is not in a sterile container.

Each and every sample should include all the necessary information about the patient, failing to do so could result in the labs refusing to carry out the necessary tests, resulting in the patient having to do the test again and possibly delaying any treatment that may be required.

All blood or potentially infected matter such as urine or faeces for lab testing should be treated as high risk and the necessary precautions taken.

The Reception Area

At the end of each day the Reception area should be left tidy. Often cleaners are instructed not to move paperwork or other items and work around them. Untidy desks therefore do not get cleaned as well as a clear desk.

Ensure that there are disposable gloves available in Reception for the receiving of samples from patients.

Any spillage in reception should be dealt with immediately and reported to the appropriate person.

Magazines and books should be replaced on a regular basis.

Toys made available for children should also be cleaned on a regular basis.

Public telephones should be wiped at regular intervals.

There should be a designated room for patients that might present themselves with a possible infectious disease i.e. chicken pox, measles etc. It is also important to inform the Doctor or Nurse that the patient is in the designated room, as often there is no tannoy facility to call patients in and often they could be missed.

Ensure that there are sick bowls available in Reception as this will be the first place the patient will come to if feeling unwell.

Ensure there are bins available in the waiting room, especially important for the disposal of used tissues, and possible a sign asking patient to place their used tissues in them.

Receptionist play a big part in Infection Control, more than we might sometime realise and its vital that they get it right, and also get the support that they require to do their job well.

Ensure that new staff have Infection Control as part of their induction training, and the necessary protocols are put in place for the Reception Area.

Talk to your Receptionists in a team meeting, often they will identify an area that may not been covered with a protocol. They are the experts in their area – RECEPTION.