The Patient's better half

The big moments in any patient's health crises are the consultations with hospital doctors, but it has always puzzled us that patients go into these totally unprepared. It seems nuts that ill people go on their own into consulting rooms, and have to remember all their symptoms. Then they have to listen to what doctors say, ask sensible questions and remember the answers. But an ill person is ill, for heaven's sake. The faculties are impaired and the chance of productive interchange between doctor and patient are minimal. Yet, I suspect that about 95% of consultations are such asymmetric affairs, where the input from the patient and the final output to the patient are tiny. The official record of the consultation will be purely the doctor's view. So, about 15 years ago, when my wife and I started going together to any important consultations, we would prepare beforehand a list of the symptoms and a set of questions. We would do this on a computer, so that we could cut and paste the questions into a coherent order. There is another reason for doing as a computer print-out; it makes the doctors nervous and aware that we are people they can't mess with. And, course, before going into the consultation, we would do a quick browse of the internet, to see if there were any relevant facts we could glean, to understand our condition better and to make our questions more to-the-point. During the consultation, it would be the non-ill person who would ask the questions and would write down the doctor's answers. This would give us valuable ammunition to fire, if the consultation was not followed by the action decided. The next stage might be to send a patient review of the meeting to the consultant, to become part of the patient's record. Cheeky! When we started conducting consultations our way, some doctors, particularly the senior consultants who were at that time completely in-computent, were shocked and angry. Younger registrars, who were enthusiastically coming to grips with the first generation of hospital records, were quite supportive. Eight years ago, I outlined our approach to a GP, who was at that time on the IT Committee of the BMA. He exploded. "You're the patient from hell," he said. "It is people like you who are driving the NHS into bankruptcy, because every consultation with people like you has to take three times as long as consultation with a normal patient." I thought he was joking, as we were in a pub quite late one evening when he said it. But I have since met some of his patients who find that fast patient-throughput is a hallmark of his surgeries! I am, however, grateful to him, as he gave me the title of these columns. More recently, attitudes seem to be changing. Nowadays most doctors – except the pushy, impatient, career-oriented ones – seem to relish our approach. One of the things that endeared me to 'Fastrack Hospital' when they started treating me this time last year for a life-threatening condition was that their brochure suggests that patients should bring a relative or friend to the initial consultations, and do exactly as my wife and I have done for years. To me, this was a beacon of light, shining in a wasteland. This was the first time that I have seen any NHS document recommend how patients should approach these all-important consultations. It is high time somebody else did some thinking.