Monday 16 September 2013

Outpatient Clinic

My wife is currently the psych SHO and last night she was worrying out loud at having her very own patient in today's outpatient clinic for the first time. She was thinking about a family sitting somewhere in the city also worrying about the appointment - would the doctor listen? what would the verdict be? is there anything they can do?

She asked me, as someone who frequently panics at her about upcoming appointments and debriefs with her afterwards, what she should do to make the clinic a good experience for the patient.

I told her that the fact she was aware how much of a big deal this appointment would be for the patient and their relatives was probably half the battle. My main tips were :
- (you can guess what I'm about to say I'm sure) Listen to me. In particular listen to what their concerns are - for example, if I am telling you that the main problem currently is fatigue then you need to address that as well as anything you identify as priorities, such as mobility or falls.
- Form your management plan in discussion with me. There is no point you prescribing something I'm not going to take or referring me to a physio I'm not going to see. Please try and understand that I am not being deliberately obstructive when I tell you I am not willing to take a drug with a particular side effect etc. I have that right, even if you believe that in my position you would choose differently.
- Specifically ask me if I have any questions about or problems with the management plan. Sometimes even the most assertive person needs permission to question an authority figure (which is how most of your patients will see you).
- Also ask if there was anything I wanted to bring up in the appointment that I haven't had the chance to mention. This is my once in a year opportunity to get your opinion, please let me make the most of that.
- Send me a copy of the letter you send to my GP - it's basic courtesy.
- Also, if you don't have a head for details I would *much* rather you take notes during our appointment than you send out a letter full of inaccuracies. To put this in perspective, I have never had an entirely accurate outpatient letter. I have had a letter which has listed 'hypothyroidism' as my only past medical history, when I have never had it, but have really quite a few other relevant conditions, letters claiming I take no medication etc. Worse than inaccuracies, are the fabrications "she appeared depressed and we discussed that her mood has been low". We didn't.

Try and put yourself in my shoes - this is a condition I am living with day in and day out - this is my one chance to talk to the doctor who manages it. Each appointment is a really big deal.

May I also recommend the excellent post on the same subject from Anya at The Patient Patient who is much more articulate on this subject that I have managed here.


  1. Good list... can I add one from my own recent experience... (not in a mental health context but maybe has some resonance)

    If I ask a question about the relationship of a current issue/recent event to a drug I am on, please don't assume that I am asking to stop taking that drug when actually I want you to try to stop the side effect so that I can take the drug without this happening again.

    Plus of course the two Prof TRJE essentials...
    -Introduce yourself
    -Ask permission before you touch

  2. I have just stumbled accross your blog and would like to tell you that you are an inspiration. My son is able bodied, I have End Stage Renal Failure and failed TX from him in December of last year after 6 years of HD). Sorry I son is in his first year as as SHO Urology and General Surgery, so I fully understand what a hard slog Medicine is. I just want to wish you the very best for a successful and rewarding career, as I said you are an inspiration and I take my hat off to you :)

  3. Thank you both for your comments - I didn't see them before now =]

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