Where is the Line?

Managing inappropriate expectations from patients.

When you feel uneasy with a patient's expectation or attitude, it is essential to know where the patient is coming from and thus to understand why you feel uncomfortable. This information can then inform your decision on what kind of boundary to set. What is it about the patient's behaviour that you feel to be inappropriate?

Patient expects more time than you have

Patients are often more reasonable that might be imagined and may not know about your time pressures. It takes a certain level of experience and confidence before a GP can ask patients what they think about his/her timekeeping and their view of the time set aside for each meeting. These are questions worth asking.

See: Some thoughts on the 10-minute consultation

See also: How to say it

“You‘re the Doctor.”

The patient wants to simply hand their problem to you.

This seems especially to apply to men who have a concept of their health based on the motor car - "If there's something wrong, just get it fixed." This is a variant of the child-parent consultation model, see: Help-rejecter

The Doctor needs to help the Patient understand that their health is the Doctor's concern, but the Patient's task. The aim should be for the patient to accept that their health is the result of their decisions and actions, and that the Doctor is there to inform and support this process but not to take it over.

Occasionally Patients have a deeply ingrained external "locus of control" which can be difficult to change.

Some methods can be seen at How to say it

Expecting things from you which GPs do not normally do in the modern world.

Patients, especially those who see their GP infrequently, often have little idea of whom to approach for their healthcare needs, and are likely to base their behaviour on:

  • What family and friends have told them
  • What they have seen on TV or read in the paper
  • Their previous experience which might be as a child, years ago

It has always been a part of the GP Receptionist's job to educate patients about how to use the service and what is available, and this task frequently spills over into the GP's interactions.

With such high levels of potential misunderstanding in these contacts, it is important for GPs and their staff to be very explicit about what is being offered and whether it is what the Patient expected. Only by asking about this can it be clear.

In some more deprived areas, it is probably true that Patients come to their GP surgery because they cannot find any other help for their problems. That the GP is cost-free is also clearly an important factor. Each Doctor has to make up their own mind about how they meet these challenges.

See Dr Chalk & Dr Cheese to throw some light on different doctor approaches.

See also Dr Cameron's Dram for some line-drawing dilemmas.

See How to say it for suggestions about diplomatic communication.

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