To think doctors, specifically GP's need to change their approach to patients

[GlasswareisOverated]

We live in the technological age. We have access to information at our fingertips, that someone fifty years ago, hell even twenty years ago would not have been able to comprehend.
Am I being unreasonable to think that drs need to lose the 'we know best about everything medical' attitude.

Obviously I won't be performing brain surgery any time soon or stripping legs of vascular veins to be used in cardiac surgery but I can read a laboratory report and understand what it means and I can get the gist of most medical studies.

"Half of what you are taught in medical school will be wrong in 10 years’ time. The trouble is, none of your teachers know which half"
Former dean of Harvard medical school, Sydney Burwell.

@Discovereads
@SkoolShoes

"Well 56% of U.K. GPs ARE women, so really not seeing how there could be a huge gap in womens healthcare by GPs."

I think the other problem with this is you can't assume that just because somebody is a woman they are going to make an excellent GP with complete empathy and understanding for women's health issues.

A female GP who has just qualified is unlikely to herself have ever been pregnant or have gone through the menopause and so it doesn't necessarily mean just because they're a woman they are going to have a full grasp of all key issues that affect women any more than a male GP. And a male GP with 20 years experience who is empathetic about infertility issues, for example, may be significantly better informed and more experienced than the newly qualified female GP.

Although having said that my GP is female and has a particular interest in women's health issues and is absolutely excellent.

@ElizabethBennetismybestfriend - that is terrible, do hope you start recovering soon 💐

That is so difficult isn't it, re his view of 111

It is an excellent service and well worth calling.

Actually my GP is the other way round! Because both DH and I spent many professional years reading masses of medical reports, letters, notes etc, he thinks we know more about medicine than actually we do!!

On another note I’ll never forget the wonderful GP I had when DS was a toddler. I took him to the surgery once and said to the GP that I was worried about him. The only symptom was that he was quiet which was exceedingly unusual for DS (still is! He can, in my grandmother’s phrase, talk the hind leg off a donkey). The GP took that very seriously and dx him with something or other (nothing major) - I can’t remember what now

GP experience is a complete gamble. Sometimes they are reasonable, sometimes not. I met about 15 in different surgeries. Also they all have a dramatic personality transplant if you mention a private medical insurance or they work privately. I totally appreciate lack of resources, but I would expect similar degree of empathy either private or NHS. I also believe they are generally more Dismissive towards women vs men. Both male and female GPS.

My son is a doctor and I discussed your message with him. Whilst the profession is keen to use technology to its maximum (online consultations where appropriate, use of telephone consultations etc) It takes a massive amount of training to be a doctor and it would be extremely unwise to rely on anything you read online. Please be very careful.

I have very little faith in GPs following some very bad experiences, including being patronised and fobbed off when politely pointing out that my late husband was showing obvious neurological symptoms after the GP diagnosed him with a virus when in fact he was developing a spinal cord compression and subsequently died from a tumour on his spine.

I have also found them very lacking when it comes to palliative care - through a professional capacity.

I can't remember the last time I was properly diagnosed by a doctor and I usually manage to identify and manage my own health problems.

Some of them are extraordinarily dim and lacking in imagination as well. One told me my recent course of metronidazole for a dental problem couldn't have led to an improvement in my gallbladder problem - which I had observed to be the case - whereas the next GP I saw explained that antibiotics are often prescribed to help gallbladder inflammation and that the metronidazole will certainly have helped.

Dealing with health problems should always be a collaborative partnership between a doctor and patient - providing the patient is able to do that - and old fashioned patronising attitudes of 'doctor knows best' need binning. Arrogance is the sign of a very poor practitioner who probably has a string of misdiagnosed, unhappy and sometimes dead patients behind them.

I often think must be so hard to be a GP constantly making high stakes decisions based on the incomplete and unreliable data given by your patients. I mean, sure you can run tests, but that takes time, which in some cases may be too late

A little knowledge is a dangerous thing.

qualified people, whose training never ceases, must be so sick of Dr. Google.

@Fairislefandango
i hope you are being facetious. I’m a dr, not a gp, and this “everyone knows they only get one day on…. ‘ is just nonsense. As with all things there are good and bad in general practice (and every field of medicine), but medicine involves study of first principles of anatomy, physiology, genetics, pharmacology, biochemistry etc which allows you to apply further knowledge to… so if I attend a week long training session or a day conference/course on a technique, procedure or new approach etc, it’s not just that stand alone day session- I am applying that to my existing knowledge. I suspect the majority of gp’s do know more than you do from googling. They give you a print out from NHS website as often patients like to have something to refer to. I doubt that they know little to nothing so just read out the NHS website instead.

I am reminded of the period when I was a junior doctor the number of times patients told me that had pain in their kidneys, but in closer questioning would point to anywhere but where their kidneys were. They weren’t being difficult- they genuinely thought that was where their kidneys were located. I think patients genuinely do think they understand everything they need to from a Google search and reading what they find. Some patients will be a lot more successful than others in the quality of that research, many will not have the background knowledge to apply what they have read even if they do come access high quality, relevant research. Not everyone, but I would estimate a significant proportion. In a similar way that I can Google things about the mechanics of cars or even an aspect of aeroplane engines/how to plumb in something/fit electrics/a technique for cutting hair/cooking a Michelin star dish or any number of skilled tasks- as a reasonably intelligent person I think I would probably get the gist of it. But I certainly wouldn’t be confident that I know better (or could complete the task more efficiently or to a better standard) than most mechanics, plumbers, aeronautical engineers, electrician, hairdressers or chefs, or that I could problem solve/work out a complicated issue in that field, based on my Google research. Same applies to medicine- I don’t even assume I know more than my colleagues in different specialties (including general practice).

As a tertiary specialist, I do find it is not uncommon to find patients think they know more than they do from their own research and often come determined of that and absolutely sure of what they want. It is great that patients have access to information, but many do misinterpret or misunderstand (common issue is confusing correlation with causation, for instance, or not being able to evaluate if a study actually shows what it claims to- especially with some of the smaller/more obscure ones they dig out— they read the conclusion and assume it is right)- not every patient, some are absolutely clued up and capable. But it does remain the case that not everyone is as knowledgeable as they think they are. There are a number of patients- usually those with quite a rare condition- who do become very expert in their condition and how it effects them and who will almost certainly know far more about that specific condition than most `dr’s they come across.

please don’t misunderstand me- I’m happy for patients to have read around the subject, and to discuss what they have read and their conclusions from this, but it’s not unusual to find that even capable, intelligent and thoughtful patients have misunderstood/misinterpreted/given to much weight to a small or poorly designed study/decided they have a certain condition and so on (sometimes because they are clinging in to hope, more than anything). I spend quite a bit of time unpicking this if there is an issue and trying to explain why I don’t agree or don’t think x is the right treatment or approach. Most patients are amenable to this, and happy to listen to the explanation, but I am finding a rising minority do feel “I’ve done my research. I know I have x and I want y because of z research/nice guidelines etc and you must do what I say” and are quite inflexible on that standpoint. Unfortunately, not all of them (I’d say the minority) actually know as much as they believe they do.

In addition, there is the issue that the average reading comprehension of adults in this country is about thought to be about that expected of a 10 year old ( I think, I may be out by a year or so either way). All of our patient information literature has to be accessible and geared to be used by that demographic, which why NHS patient information leaflets can seem insulting or needlessly basic. It also means that perhaps the understanding of what they have read is not always quite as robust as they believe. I am not saying for a minute that all patients are unable to read information and form a reasonable conclusion.

That's a very interesting thread. Personally, I do believe there needs to be a change and/or an adaptation of patient care in general, but I wouldn't hold my breath that people "understand more these days". Unfortunately, we live in a weird time. There are people like the OP has said, that can understand a few things, and there are many people that cannot differentiate between real medical information and wild conspiracy theories and misinformation.

The real issue is not enough GP's - 1500 less than in 2015, many more working part time.

Primary care is wrecked, total lack of work force planning.

I think like a PP said, patients are able to become 'experts' (for want of a better word!) in specific conditions perhaps but its obviously much more broad for an actual doctor.

For example, I have a genetic condition. I've met GPs and other doctors who don't know what it is or what it affects. I definitely do know more about it then a lot of the doctors I've met, aside from the genetics doctor I eventually for referred to of course. But that's in one very specific and personal subject. I do not know more or as much as doctors in regards to medicine or diagnostics in a broader sense.

I do get the gist of what you are saying and some drs are quite precious about them knowing it all. I had a particular consultant when I was mentally unwell. She suggested I try a medication. I asked her if she had a BNF (I'm a nurse) that I could look at quickly before agreeing. You would have thought I'd said the worst thing in the world! BNFs are not for patients she said! Then refused to give me any medication!

Another time on an acute psychiatric ward I was given a drug test which came back positive. I knew I had not taken this drug! I did some research and found a false positive was due to a medication I was on. I spoke to a nurse and asked them to pass it on to the consultant. They were very apologetic (leave was stopped immediately on me failing the drug test) and thanked me for finding that out. So, they aren't all the same.

In general I think it’s great that people can find out about their health on the internet. Education is King and can lead to healthier choices.

That being said, I don’t think just Googling lab results and coming up with a diagnosis is ideal because it’s all about context.

If you wanted to have people relying on the internet, then you need to have a good system of removing sites that give false information.

I remember googling about something I know a little about.
The number of websites there were (especially American "I'm a doctor and I know all about this and will tell you more if you send me some money") giving not just false but directly bad information.
Of course they were filled with testimonies "I never understood what I had until I came across you and now I know everything so I've stopped taking the medicine my doctor prescribed and after nearly 16 hours I feel better than ever..."

And how many people know how to read a medical paper? I'm fairly knowledgeable in both medicine and science and I wouldn't claim that I could do that generally. Some subjects that I know more about, I could have a decent shot at, but I still don't think I would have the capability to do that. I think sometimes it's a case of the more you know, the more you don't know.

I've had a skin condition diagnosis and treatment without even being seen!
I had to suggest they might like to see pictures. (They've been ignored)
I've been on steroids for months with no visual examinations at all.
I've had to fight for a referral. It's ridiculous.

I think some doctors have taken on board that many patients are more informed now. I've been really impressed by my GP practice, not just the GPs but the nurse practitioners and the reception staff in general. Although from what I've heard from friends, I'm just lucky with that particular practice.

Some consultants and NHS physios though...hmmn. Its rare to meet one who is not patronising and who doesn't talk down to you. I've had to ask them to use specific, clinical terms a couple of times so that I can actually understand what they are trying to say, rather than something like "your painful knee".

Enough studies have been carried out to show that the medical profession, in this country at least, has a bias against women and in favour of writing them off as being "the worried well" without proper investigation. There is enough case law to prove that its really not particularly uncommon. I've had bad advice, and I think, in my (relatively well informed) case at least, its safest to be my own advocate.

I would compare it with the difference between both experiences of giving birth. Studies have found that even if the outcome is the same, women who were supported on decision making had better mental health outcomes than those not.

After my first birth I was traumatised.
Before my due date - "We'll book your induction for ten days after due date"
"Let's give you another half an hour then start you on the drip" and so on. No discussion just this is what we're going to do to you.

Compared to "This is what the NHS policy is, this is what the options are and this is what I think, what do you think? Do you have any questions?"
I felt like we were partners in decision making and had full trust that they were advising what they felt was in my interests, not coercing me in any way and not just dictated by policy.
It was a whole world of difference and meant I trusted my midwife implicitly, rather than feeling it would be frowned upon to explore my options.

It's the sort of partnership I'd prefer to have with my GP too.. One where the patient is able to assume some responsibility.. Especially one that recognises that I'd prefer to make lifestyle of dietary changes that have a lasting effect, rather than go straight to medication.

Agree with this. Doctors often get poor treatment because people assume they don’t need explanations or the same level of enquiry. I am an A&E doctor (as well as a GP) and had to work quite hard to get someone in A&E to do a proper history and examination when I had what turned out to be appendicitis.

There IS a huge gap in women’s healthcare, even by female GPs. There is also a lack of research (not their fault).

I know more about the menopause than my GP, and she’s supposed to be the ‘specialist’. So in some cases no, YANBU.

Having said that, obviously some patients will not have a scooby doo about their bodies. But some will. I do wish GPs would listen to people who clearly know their own body and have a hunch about what might be wrong rather than the ‘we know best’ approach.

People who think general practice is easy and talk about ‘bog standard’ GPs are exposing their ignorance.

I’m a GP but I also have a sub-specialism within hospital emergency medicine. Not going to say what as it’s rare and quite outing, but there are probably fewer than 10 other doctors in the country with the same level of professional experience in it. That part of my work is interesting and has its challenges, but it’s a million times easier than general practice.

A hospital specialist usually sees patients a long way down the diagnostic line. Often the diagnosis is already made; invariably there have been blood tests, scans etc. Usually the specialist is offering expertise on managing an established diagnosis.

A GP sees completely undifferentiated symptoms, usually at an early stage. Every consultation could be something life threatening or a stubbed toe. Lurking amidst the apparently trivial can be cancers, sepsis and other urgent problems. There is immense skill in differentiating the serious from the minor. I have had cancers present as a blocked nose and a sprained ankle. Mostly the patients have not had any investigations. GPs have to spot what needs further tests, choose the right ones, interpret the results correctly, refer if needed. And that’s just the diagnosis side. They also have to manage literally any physical or mental condition, 90% of the time without any specialist help.

I understand some other nations have patients able to access specialists directly. I think possibly a majority of patients seen here genuinely don't understand enough about there new symptoms to see the correct specialist without in effect a GP-lite triage, let alone the vast majority of patients for whom diagnosis and treatment is successfully managed in primary care. Putting aside Dunning Kruger, I would support such direct access, if only to allow a primary care system currently being deliberately sabotaged by the English government to better balance demand and capacity. I doubt the specialists in acute would appreciate the increase in direct access for patients mislead by Dr Google and their own ignorance of the limits of their understanding (not to say the patient is not the expert in their own symptoms, just that many have firm and completely incorrect understandings of what is the cause of those symptoms) and the increase from patients currently successfully managed by primary care.

For those talking about obsolete medical school tuition, if only there were CPD and training available or some means of communicating recent research, possibly in the form of online journals and protocols.

Will no one think about the non-vascular veins.

we know best about everything medical' attitude

I honestly think this has been out of fashion for > 20 years. I can't tell you what individuals will be like, but new doctors & nurses are not trained to think this way -- and don't want to be perceived that way, either. They have sat thru long lectures about patients & clinicians as "co-producers" of good health. That said, most people would like confident advice from their health carers, not a zillion options with no confident endorsement. Like you would want your car mechanic to just make one confident recommendation not give you 16 options of which mechanic doesn't personally like 15 of them.

When you're feeling terrible, you most want a simple recommended treatment to talk about and understand, not to have to do a lot of decision making.

Given men have far worse health outcomes than women, adjusted by age/deprivation/any specific condition, it makes sense to me that men should have more money targetting their health needs. <ducks & runs for cover on that one>

I have non-vascular veins. I call ‘em the prosecco pumps.