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?

I think it depends on the context. If it's said in an exasperated way then I can see why people don't like it but some people really are not clear about what they want & you don't know why they keep turning up.

I work in health care. I may do a long assessment, come up with a diagnosis & suggest a number of interventions , all of which the person declines - so I may ask if there was something specific they were hoping I would offer or if they had any particular expectations of the appointment. I don't think I am being stroppy. If they were expecting something my service can't offer, I can redirect them. If they want an intervention I don't think is appropriate we can discuss that. If they didn't really want to come but their family pushed for it - very common in my specialty - then that is good to know. They may just have wanted to have a vent & then not make any changes, also good to know. Sometimes I may have not offered something that they would be interested in, so we can move forward if they tell me that.

Radiolology — like radiology but for people with interesting items up their bottoms.

Really poorly phrased but can’t deny I’ve fantasised about (but definitely not said) saying something similar when being given a list of random symptoms that have nothing to do with my field.

I suddenly realised, when I heard this for the 3rd time recently, that it must now be a thing.

The first time the GP actually said, "What do YOU think it is?" as she was Googling it, so I told her to Google what I'd already googled. FFS.

The last time I had taken my elderly DM in, who has Alzheimer's but was complaining of leg weakness and shortness of breath. As she is 82 I figured a GP should check her over just to make sure it wasn't a heart issue, and after a very brief examination was asked what I expected from the consultation. I looked a bit blank and suggested that reassurance that I wasn't overlooking a serious illness and that she wasn't going to collapse and die alone in her flat might be useful.

The last time a hcp asked me this I gave them a blow by blow list of what they needed to do I told them I needed blood tests booked told them which ones asked for a full blood count at the same time detailed the medication I needed a prescription of told them if they wrote it now I could get it filled after I had the bloods done it went on for a fair few minutes she said well i was thinking of sending you to the specialist for this i said that's fine but he will want me medicated first

Yes i know my condition well and know the specialist well too

Some people won’t, but many do come in with a specific thing - for example “I want HRT” or “I want a scan” . Identifying this early allows us to focus more on what you want to talk about - rather than me waffling on about things you’re not interested in

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

Mmmm, but you’re the doctor. The NHS has finite resources, and you should only be sending someone for a scan or giving them expensive drugs if they need it, not because they’re a pushy person who's heard of such a thing as a scan from Casualty, or their friend had something similar and such and such a drug did wonders, and now they insists they need X, Y or Z.

I was asked similar by a Jr doc who took a history of events of my DDs UTI prior to seeing the consultant. The question ‘what do you hope the outcome of today will be’ made me feel like I was being assessed for Munchausen by Proxy!

I don’t think for a minute she was saying that she always gives them whatever they’ve asked, it just opens up a conversation as to whether it’s practical to have the investigation/treatment, and the HCP can then use their medical expertise to provide reassurance why it isn’t actually necessary, or appropriate, or the other things that need doing/trying before they meet the criteria for the thing they’re asking for.

'To me it conveys that the doctor finds the patient’s very presence unreasonable.'

This. It's appalling wording. Aggressive and sarcastic. If (this is to the doctor PP whose username I can't remember - apologies) this is the exact wording you are being taught in your training, you need to be feeding back how inappropriate it is. And your training needs to have a linguist on board.

The GP said this to my 14 year old. It wasn't helpful in the slightest, just made them feel judged.

I bloody hate this phrase. I don’t like going to the doctors as it is, it makes me extremely anxious. This phrase makes me feel like I have done something wrong!

If I were to use this phrase when trying to help a customer in my job, I would at least be facing a disciplinary!

When I've been asked for my last couple of appointments for my depression it's felt like code for: 'clearly treatment just won't work for you so why do you keep coming back and wasting our time?'

I'm dreading being asked at my appointment next week. Feel like fucking cancelling!

This thread is highlighting that there is a gap between what is a good idea in theory, and how the idea is being applied in practice.

@Kazooboohoo you’ve misunderstood me. It’s not “giving them whatever they ask for”, it’s ensuring we can have the right conversation about what they want and if it’s appropriate/ what other options might work. Exactly what @QueenOfPain said.

Sorry PPs find it offensive, I agree it does have to be worded carefully

That wording seems rather passive aggressive to me.

I am not medically qualified so when I go to the GP I try to present them with the problem, not what I think the solution may be.

(I am often right though...)

It is similar to "How can I help you?" but does not have the same set of associations as a phrase.

It is too like "What do you want ME to do about it?" which as it is used ime in a UK context means "You are asking too much of me!"

It’s a long time since my training but one of the things we were taught - particularly with patients who visit for seemingly minor things on a regular basis - is that there is often another reason they are concerned about their health but are too scared or embarrassed to volunteer it. The example given was a person who visits regularly with a painful thumb (not swollen, no trauma, no arthritis, full range of movement etc) and then on the 7th or 8th presentation when asked directly what they are wanting from the consultation finally mention their rectal bleeding.

We are also now being taught the benefit of “values and outcome” directed therapy rather than “goal directed” where the obvious solution to a problem (eg surgery) may not align with what is important to the patient (particularly if one of the known results from surgery means the person won’t be able to do the one thing they currently manage and enjoy).

I agree though - “what exactly are you expecting me to do” is a horrendous way to phrase it. It sounds dismissive, arrogant and rude, partly what the whole ‘include the patient in their care decisions’ was meant to avoid!

I see Custardy has used that exact phrase a couple of pages ago!

How do phrasings like this get past any consultative stage of training development?

The problem with introducing a new type of question is that the patients dont get the same memo. As a patient we go to the doctor and expect what we have always had. Get presented with a different question from normal and we dont know how to answer.

The underlying aim of this is laudable, but it is being implemented, in some cases, in a ham-fisted way that is damaging the doctor/patient relationship. It seems to show zero understanding of basic psychology. If a HCP generally has a good bedside manner it will work. For those lacking in that department it could have dire consequences, eg as the pp mentioned for those with severe depression who leave the surgery thinking the HCP views them as a nuisance, or - worse - that there is no hope for them.

The RCGP should provide further guidelines on phrasing the question in ways that will be received as helpful and empathetic.

That particular wording is bad yes. But I actually like it when GPs ask me “what would you like to happen” or “is there something you have in mind” or similar.

Quite often I do have a specific treatment/test/referral in mind (being an intelligent person with Google ) and this question lets me get to the point quickly without feeling like I’m being pushy.

Of course if what I have in mind is not appropriate or sensible the GP can and will tell me.

I would find that phraseology quite very confrontational and feel wrong footed from the start.

But perhaps that’s the intention. 🤷‍♀️

@bobbypinseverywhere I appreciate your input!
Sadly I see a lot of Drs so I’d worked out early on that they “have” to say this and I t’s not a personal dig. But sometimes it’s just a kick in the teeth. Especially is you then list some things you thought up (maybe send me for tests/refer me/prescribe something) and they tell you why they’re not going to do that. So why ask? Why keep asking me? I don’t know what I need! Anything I suggest gets pooh-pooohed so what’s you suggestion dr? And we could have saved 5 minutes if we hadn’t been doing this dance and you just said whatever you’re going to say in the first place!

As ever a problem with this is that done well it's not necessarily going to save any time, whereas done badly it might as the patient will just shut down.

I've sat in GP appointments with my schizophrenic husband, i know why they ask this but i watched him crumple when it was said even fractionally off the perfect line. In the same way i know why they ask him to go through the past history but in one case he walked out because hed been answering tjose questions for thirty years, and in another case it meant they totally missed his current state of mind and it contributed to him taking his own life the same afternoon.

I do think that much more subtle research into communication is needed. We should be way past 'active listening' and rapid acronyms by now. But if there must be acronyms, how about 'TeMYT' - Tell me your thoughts on this. Research that one maybe? What do you expect is indeed confrontational and its too fast - jumping to the outcome when the patient is still recovering from having to come in and share their symptoms in someone elses territory.

I've had a Community matron ask this when DD ( very sick, permanently) was screaming in pain and crying and I was crying because none of us had slept for three nights due to her pain levels. I wasn't very pleased and I think I just said 'something, anything ". It felt bloody stupid of her and I now always try to not have that person come for a home visit.

But later that winter she was very very kind on New Year's when she came out on her days off to administer drugs via my daughters port a cath so we could be at home ( having been in hospital all over Xmas). I'm reasonably certain she was working from a script because she had no idea what to do. But I need medics to at least try. DD doesn't have a minor condition and I deal with it 24/7 every single day, no time off for me