Sooner or later you are likely to have an encounter with a doctor. Once you enter the land of dotage it comes with the territory, and very few get by without something failing to work in the body in some way. I know that the body is more than the sum of its parts, and they are all linked, but each has a function from a medical point of view and the moving parts are often the ones that fail first.
The art is to know how to approach someone who can hopefully fix it, and here there are a number of possible pitfalls. So it is best to think ahead a little to try to negotiate a path through the consultation to come and a sound plan here will be of great advantage. Your next encounter may be down a telephone, across a desk or even, god forbid, from a trolley in a draughty corridor in A&E. Whichever it is – the same basic rules apply.
As we all know, the NHS is not what it was when we started out with it. No more avuncular chats with middle-aged men wearing sports jackets that have leather patches on their elbows and who are thumbing through brown envelopes of notes. Nowadays, all options have to be discussed, and all eventualities covered as the computer protocol demands and the bright young woman doctor evaluates and interprets. Because there are more patients, more lines of treatment and greater expenses involved; there is constant pressure on the doctor to stick to the script, so it is useful to have an idea of what that is.
It pays to know you are going to be unwell several weeks in advance. This is not as foolish as it sounds. In the current state of the NHS, you probably won’t get a telephone appointment for a week, or a face-to-face consultation for a month, so you need to have a plan. Many people worry for a fortnight about something and then ring up and demand a same day appointment.
Much better to worry for a day, make an appointment for a fortnight hence and then cancel it when the worry disappears three days later. Worry is your adult brain telling you that something is not right, while your child brain is asking ’Do I really have to do something about it, can’t I put it off and see how it goes?’
If your inner child has a big influence on you, this anxiety can go on for weeks and then end in panic and a rush to A&E to join the queue for a young doctor more familiar with dealing with trauma then worry. So the first thing is to consult a sensible neighbour, friend or family member and ask what they think about your symptom, but make sure it’s not someone who is just going to inflate your worry and possibly add theirs as well.
That someone may well be the internet and a hospital in California which would love to consult you about your worry as long as you can pay their fees. There are many sites out there whose sole purpose is to inflate worries, so bear this in mind. If possible – book an appointment with your own doctor, not any doctor who may be a locum and unable to follow up anything required. In theory, he has your notes in front of him, but as they are on a computer they are not as well-thumbed as the old brown envelopes and carry less meaning.
Then, once you have decided on a consultation, think about whether you want a telephone or face to face. And think carefully – they are different animals. A telephone conversation is between two adults sharing information and is mainly useful for the description of symptoms and discussing whether they are significant. From the doctor’s end, she is trying to assess whether your symptoms mean cancer or heart disease instead of just a normal adjustment to the current viruses or aging process. This is because 50% of the over 70s will eventually succumb to these and it is bad for business if they are missed. If she has any doubt, she will want to see you and use the cues which sight and touch add to her diagnosis, not to mention blood tests along the way. Of course. one of the exit ramps is the venerable blood test, which she can use to buy time in the event that an endless discussion is going nowhere. If you want to stay in the game, you must make sure you are well prepared.
So have a plan: think about what important points you want to get over and write them down. Keep a diary of symptoms, so that when asked how long it has been going on you don’t reply ‘Ages’ or ‘A long time’. This is especially important for vague, intermittent events or symptoms if you want to be taken seriously. Remember you doctor is always looking for a reason to reassure you and move on or else bring you in for a face to face (next month).
If you want the latter, you should present your case in a cogent way by describing symptoms accurately and without emotion. Never, as in law, ask leading questions like ‘Do you think this could be trapped wind?’ Answer: it could, but where does that get you? Be clear about your symptoms – their duration, what makes them worse or better, when and how they started and how they affect you. Give a good clear history and then be prepared to answer the questions that follow rather than offering your own interpretation.
You are allowed to search the internet beforehand to educate yourself but you may well find more information than you can deal with and end up more confused than ever. Try and restrict yourself to Wikipedia which is straightforward but may be too technical. If you say ‘I read on the internet/Daily Mail/Facebook….’ you may be consigned to the bin labelled ‘Worried Well’. Also, be careful if you go down the road of alternative medicine during the exchange; remember that your doctor has spent at least nine years studying science and may not take kindly to having her foundations challenged.
Much better to say ‘What is your opinion about….?’ to keep the ball in her court and force an opinion which you can then gently expand on. Another useful expression is ‘What are my options? …’ which is more likely to result in a satisfying conclusion and give you time to consider all eventualities. Bear in mind that the fundamental reason for the call is to elicit information and not to complain, air a grievance or show off your knowledge (which may exceed the doctor’s if you have been studying Wikipedia all evening on the subject of, say, tinnitus). If you have a particular concern, voice it at the end of the consultation, e.g. ‘To be honest I am worried that I may have bowel cancer’. That denies the possibility of simple reassurance and forces a serious discussion on the possibility (unless it is accompanied by floods of tears).
If you do proceed to a face-to-face meeting, you will likely have your body examined, possibly intimately. That is why you are there. Take a small specimen of urine with you in a clean bottle. You will likely know which part is going to be examined, so make sure it is accessible and clean. There may well be a student or chaperone present so be prepared for that. Unlike the old days, this is not a social event with an old friend, it is presenting a body for scientific study which happens to be yours. Treat the encounter accordingly but make sure you leave with ‘Was there anything I need to be concerned about?’ or something like that.
If you do find yourself referred to a hospital doctor, then there may be a consultation which is something of a combination of the two. First a line of questioning when he drills down to get more information of the symptom, then a physical examination. Remember to have the answers ready and concise, and have your questions written down beforehand. You will only have one chance to ask a straight question, so grasp it firmly and if necessary write down the answer as you may be rather emotional.
Doctors are human and they have their hidden agendas, but they are fundamentally on your side which is why they took up medicine in the first place. Sometimes, however, they are on the side of your body and your ideas and prejudices may get in the way so they appear arrogant or dismissive. The best consultations are an interrogation, or rather an inter-rogation. You are asking them and they are asking you, so together you come to the truth of what is happening.