What exactly are you expecting me to do for you?

[orangeshoebox]

aibu in thinking this is the most useless sentence said by a healthcare professional?

who has decided that this is a good thing to say to patients?

who has decided that this is a good thing to say to patients?

Presumably GPS who see a whole load of people who turn up expecting to be cured for things the GP can’t actually do anything about. Finding out what the expectation of treatment is, helps the GP be able to manage it.

@timshelthechoice what I’m trying to explain is it isn’t supposed to mean

“Tell me what you want me to do as I don’t know”

But rather
“Is there something specific that you have thought about/come across which you think might help or you might like to try”

It’s not because we don’t know clinically what to do! It’s because sometimes people might put 2+2 together and make 5, or have heard about a treatment in the newspaper they want, or just want to be reassured it’s not serious.

It stems from idea that people are stupid, bobby, which seems to be a very prevalent attitude in medicine, and sad. I realise it's nothing personal, just institutionalised patronising. I would think most HCPs would be able to use their brains and make their own judgements rather than relying on twaddle like this, a bit like you have to drive a certain way to pass the practical test, but then you're free to use your brain to control your car how you see fit, IYKWIM.

@lazylinguist

Actually because some patients want different things! For example someone has 2 weeks of stomach pains - that question can reveal the crux of what they are worried about. Of course I would assess everyone thoroughly the same, but then they might say
“ my dad died of bone cancer and I’m worried I’ve got it”
“I’ve got a meeting tomorrow I can’t miss and need painkillers to get thru it“
“I want to be tested for food allergies”

So everyone would still get my medical assessment and recommended investigations, treatment the same, but hopefully they won’t walk out the room annoyed that I didn’t offer them a cabbage allergy test or immediate full body MRI scan, as we would have identified this and covered it.

The way we were taught at medical school was, you have to elicit Ideas Concerns and Expectations to pass the exam (because it is a tick-box) but you don’t necessarily have to do this in such a rigid way in real life consultations.

I LOVED it when she asked me:

"what is it you would like me to do"

Me: "I want an x ray, to talk through different painkillers - actually I've read about them all online and I'd like to try Gabapentin first as I don't want one that makes me space out. I'd also like to hear about any pain management clinics you offer"

Her: Great. I can do all of that.

It made me feel I was actually involved in figuring out what I needed.

@timshel it really doesn’t stem from the idea that patients are stupid. Genuinely, in its essence, exactly opposite.

the whole point of it is to “redress the power balance” from a paternalistic, doctor centred, to more “even” patient centred. If you don’t believe me, and are interested- google it - there are hundreds of books and research articles on “ICE”.

Actually I’m really not defending it as I don’t love it anyway - buti train junior GPS and know they struggle with learning how to do this.

I was just trying to explain that Drs really aren’t always trying to belittle and insult patients. Sometimes we are actually trying to be on the same side! Not against patients, that’s the point of the job. But I’ve been on mumsnet long enough to know GPs are hated more than dogs on here so I know it’s a losing battle for me!

Hopefully if anyone was interested they may have found my input slightly useful anyway

I work in a&e. I have said this to patients who have declined every single option I have put to them. I use it to get an idea of their expectations and to set parameters of what can be offered right there and then, and signpost onwards. It can be a very useful sentence, said in the right context and tone.

But I’ve been on mumsnet long enough to know GPs are hated more than dogs on here so I know it’s a losing battle for me!

I

This is interesting. My elderly DM had a fall a couple of years ago and I rang her GP to ask whether a home visit would be appropriate. The GP said on the phone exactly what you said in your OP - “What is it that you expect me to do?”

I was very taken aback. I said (politely) that I wanted mum seen by someone who can assess her to see whether she needs any treatment, but I was actually furious. (It didn’t help that the GP came out and said DM was fine, then DM collapsed again an hour later and spent 3 weeks in hospital with gastroenteritis, a chest infection and a UTI.)

I really think this approach needs to be considered carefully so that patients don’t feel as though they are being a nuisance.

This pissed me off a lot. I finally went to the GP after suffering daily headaches for months and she said, "What do you want me to do about it?"

Um, find out why it's happening and stop it?

Just say you want loads of opiods.

Dh went to the gp with symptoms of bowel cancer. Various blood tests were done and were in conclusive. I was with him this this appointment. The gp asked if he would like to go home and try different things with his diet (no suggestions from her), or would he like to be referred for further tests at the hospital. I said further tests would be my preference and he agreed. After several cancellations and rebookings (kept getting bumped down the list as a healthy young man) he was finally diagnosed with bowel cancer a 6 months later. He says he'd probably be dead if I hadn't been there as he would have just gone home. It wasn't a good experience.

Someone I work with says to people that contact her 'what is it you would like me to do for you?' so she can manage their expectations from the outset.

I think it sounds fine.

Another GP bashing thread!?
🙄 Do people actually want a health service or are they happy to constantly berate their doctors and nurses until no one wants to do the job anymore? They have 10 minutes OP.

Also you do realise that often Consultants ask GPs to prescribe things that they cannot prescribe, because it’s a hospital only prescription, off licence, they haven’t provided clear instructions for a novel drug that is be given or it’s at an unfamiliar dose.
But yes let’s continue to blame the people firefighting at the frontline.

YABVVU. Especially as you have misquoted me from another thread, where you were giving incorrect advice about a subject you evidently are not qualified to answer.

I actually like the concept, and handled well, it can be very helpful. For example, I have a condition that complicates pregnancy. With dc1 I was basically told I had to do/have X,y and z. It felt quite scary to challenge this, as although I'm happy to take risks with myself within reason, I didn't want to do anything that could be risky for baby.

With dc2 I was asked what my expectations were, how they could best help. That made it so much easier to say is like to try a,b,c and avoid X and y if possible. The end result was the same in both cases, but the question certainly helped.

I really appreciated being asked this.

I went to GP with drepression-type symptoms. When asked what I wanted I said:

"to be able to sleep better at night. [PAUSE while i thought about that]... Could I try sleeping tablets?"

I'd not considered sleeping tablets before. It totally worked. I could easily have ended up down the anti-depressant and councilling route if I wasn't asked directly.

Oh, I like the concept of understanding the patient’s hopes and expectations, so that you can both meet and manage them as appropriate. However just saying “What do you expect me to do” can seriously wrong-foot a worried patient and could be very much counterproductive.

I hate this question too. It makes you feel small, stupid and guilty for daring to be worried about something. In my mind it's them saying "what the fuck do you want me to do about it?".

I agree it's often said too soon in the consultation. I want to be reassured whatever it is won't get worse if ignored or I want to be treated for it if possible. I want a diagnosis.

informed consent is great.
I'm not bashing gp/hcp but I think they communicate better.
that question without first assessment and treatment or pathway options is shitty though.

Perhaps I'm too bossy but I've normally formulated a plan before I go to the Dr - ie I'm sweating excessively, shaky in the mornings and sometimes feel dizzy - I think it would be a good idea to do a blood work up including a fasting one.

Or - I'm concerned about a persistent pain in my throat not accompanied by other illness, I'd like you to refer me to an ENT specialist.

I thought everyone did the same.

ironically enough we are being taught to say this to try and explore patients “ideas, concerns and expectations

Yep, and we are being taught to teach doctors to use similar phrases. Patient centred care and all that.
There are better ways around it though.

It's not very different to "how can I help you?"

It's a YABU from me.

GP used to use this. I stopped seeing them as it came across as aggressive, standoffish and an exertion of control. The panic attack wasn't worth it.

YANBU.