"Oh, right. I'm Dr ..."
"Now before we start, I'd like to record the consultation on this cassette player."
"Er ... why?"
"My wife wanted to be here but can't. If I tape the conversation, she can listen to it later."
"You're not a journalist, are you?"
"And you're not going to sell it to Richard and Judy?" "No, it's for my personal use only."
"And what do you want to talk about?"
"I've just come here on a preliminary visit to find out if you're the sort of GP I want to look after my family."
"Well, I'm not very happy about being recorded." "It'll be fine, doctor ... Trust me, I'm a patient."
Is this a real consultation, or am I off on another flight of fancy? Neither - it's a transcript of a simulated consultation between a real GP (from Cambridge) and a role-player (me). Thanks to the epidemic of complaints against doctors, this method of consultation skills training is all the rage. I've been dabbling in the dark art of patient simulation for four years, and the trick is to make the doctor sweat. The consumer from hell ....
"I've brought this copy of Which? with its Good GP Checklist. Question one - can you guarantee that my wife will always see a female GP?"
"Well ... um ... we've got two female partners so she can certainly register with one of them, but in an emergency she'll just have to see whoever's on call."
"Right. My wife and I both work and we can't get to the surgery before 7pm. Which days do you do late surgeries on?"
"We don't. Our last booked appointment is 6.30pm."
"So we'd have to phone up as emergencies?"
"Only if it really was an emergency. Otherwise you'd have to take time off." "That's not very patient friendly. Very poor. Now my grandmother."
"She lives with us and is housebound after two strokes. Her previous GP visited her once a week. Can you promise to make a similar commitment?"
"It would depend whether she needed the services of a doctor. We have a large elderly population and what with all our other commitments, we can't visit people at home unless it's absolutely necessary."
"Oh, believe me, it's necessary. And my son suffers from asthma. If he has an attack, can you guarantee he'll be seen promptly?"
"Because my wife phoned the surgery to check out the receptionist and she was rather brusque."
"Well, that does surprise me. Both our receptionists are extremely good."
"And they've been trained to recognise medical emergencies?"
"They're trained to refer anything they think might be an emergency to a doctor."
"Yes, but that's not what I asked, is it?"
By now the GP was getting a few beads on the forehead, but still managed to maintain an air of calm professionalism. Time to turn up the heat.
"My wife suffers from ME and has met a lot of prejudiced and ill-informed health professionals. What are your views about it?"
"I think it exists but we don't fully understand it."
"Do you think it's psychological?"
"Um ... I think some people are incorrectly labelled as having ME when their problems are psychological, but I also think that others do genuinely suffer from very debilitating post-viral illnesses."
"She sees a consultant privately who's started her on interferon injections. Would you be able to give these free on the NHS?"
"To be honest, I've seen no evidence that interferon works in this situation."
"You're not thinking about the cost?"
"Well, it is very expensive, but I'm more worried about the fact that it doesn't work and whoever's giving it to your wife privately may be ripping her off."
"Don't forget you're being recorded."
The four GPs who did this scenario had all experienced fierce consumerism but none had been taped by a patient. "I felt completely dominated, as if I had no control," said one. But would they take the family on to their list? Two said yes ("all patients deserve a chance" and "I'm the only GP for miles so I have to"). The third was undecided - "I'd like to phone up his last GP and find out why he left" - and the fourth was a senior partner with communication skills to match.
"Where do you live?"
"I think you'll find it's outside our catchment area."
"But it's only a mile away."
"Yes, but our area's a very odd shape, like a piece of Swiss cheese. There are these little lacunae that we just don't visit."
"That is a pity."
"Yes, isn't it? Goodbye."Reuse content