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The apprentice - Dr John Paul Campion

Dr John Paul Campion, a GP registrar from Mid Leinster, knows all about the importance of having a clear head during consultations

As a trainee GP, the communication issues that you deal with are entirely different to those faced in the hospital setting. The patients are coming into your working space and bringing their issues and agendas. However, as a doctor, being aware of your own issues is equally as important for effective communication.

Recently, I saw a difficult patient during a morning session. He and his wife, who both didn’t speak very good English, were demanding an antibiotic for an apparent viral illness, and despite my best efforts I could not convince them otherwise. After a prolonged exchange I felt left with no alternative but to prescribe the antibiotic.

Naturally, once the consultation was over I had a mix of emotions; anger and frustration were at the forefront of these. There were lessons to be learned – but the biggest came just a few minutes later.

I called my next patient in, a 16-year-old boy accompanied by his parents, and began as I would any consultation by asking why they had come in. A very emotional mother began explaining how she had been called into the school by the principal to discuss some worrying texts sent by the boy to his friends over the weekend suggesting that he was planning to take his own life. His grandfather had died by suicide a year ago and a close friend by the same means some three weeks previously.

As is my usual routine, I had begun taking notes and she took exception to this, perhaps feeling my full attention was not on her problems. Still pumped full of adrenaline from my prior patient encounter I was defensive of my actions initially…but thankfully realised my position and changed my approach given her evident upset.

Having done this, the rest of the consultation proceeded well. I spoke with the boy on his own for a few minutes and again with his parents present and came to understand the situation better. They left with a clear plan in place to liaise with local psychiatric services that afternoon and were clear that they could return at any time to speak with me again.

The main lesson I learned was that you never know what the next patient brings. It is vitally important to finish one consultation before beginning the next, both physically and mentally.

Roger Neighbour, in his 1987 book, The Inner Consultation, called this ‘housekeeping’ and it means being sure that you are in the right shape to see the next patient. Easier said than done in a busy clinic setting, but essential to prevent communication breaking down before the patient even enters the room.

It is vitally important to finish one consultation before beginning the next, both physically and mentally
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