"Thursday, Thursday, Thursday...."

I had a meeting with my GP this morning, also the practice manager and a professional mediator. I found it quite harrowing but I'm hoping good things will come of it. Get me, ever the optimist....

I'm not dead yet!*

The background is that we had a mix up a couple of months back, I won't bore you with the details now, I may follow up with them in a later post. As well as the mix up I was getting fed up that I often find it really difficult to talk to my GP. She often interrupts me and doesn't let me finish what I'm saying and she often appears impatient. It's frustrating.

As a patient with a chronic health condition I need to be able to talk to my doctor. I need to feel she is listening and I need to have confidence I am receiving a good standard of care. When I don't feel listened to I become concerned that any treatment recommendations being made may be ill considered and that important factors may be being overlooked. I am mindful that as an autoimmune hypothyroid patient I will typically have multiple symptoms which may be linked to my thyroxine dose, or something else needing to be addressed - and I am liable to pick up other conditions too. Symptoms can be caused by the thyroid condition and also by other things which may be wrong.

I am fiercely determined to be as well as I can be and to advocate for myself to receive the best possible healthcare. I also feel passionately that many other patients with chronic health conditions also deserve the best of care and may not be in a position to advocate for themselves as strongly as I, with my years of experience as a professional communicator, can. So I am committed to holding medical professionals to account to provide a good standard of care for everyone.  Oh and of course, when I am not as well as I am now, my own communication abilities are debilitated and I simply can't be doing with every conversation I have with my doctor being a struggle.

Today's meeting came about following a series of letters exchanged between myself and the practice. Each letter I sent was hard work for me to write and was only done because I felt I had no option. I had kind of reached the end of  my tether with them. To their credit the practice have been totally on the ball and responsive with each communication. I have faith in their good intentions. I recognise they work with systemic difficulties which are not their fault.  I have faith that my doctor is a good, knowledgeable and committed doctor. But she unfortunately is working under extreme pressure so is constantly having to prioritise and work as swiftly as she can and that means the service she can provide may always be somewhat compromised.  In addition, I think that after today the penny has dropped for me that her sometimes unfortunate communication style is nothing to do with me but comes of being someone who is intellectually super bright but doesn't have strong interpersonal skills.  I had been worried that her behaviour towards me meant she thought I was a waste of space. I'm reassured after today that I don't think that's the case.

While I would love to have a doctor who is warm and empathetic I feel it is more important that I have one who is efficient and on the ball. Ideally I would naturally like to have both but at the moment, with the NHS in the mess it's in, I fear that might not be possible. I just don't know. Are my expectations too low? Certainly changing doctors, while an option, is no guarantee that I will end up with anything better than I've got now. *sad face*. Actually I'm being unfair, she is genuinely empathetic, she just isn't always great at expressing that empathy.

We had a big chat. I reached the conclusion that she will probably always be quite hard work but that she knows her stuff, medically and that she does have my best interests at heart.  We agreed to work at the relationship and hopefully over time it will improve. As this is what both sides want I am hopeful we can make it work.

The mediator and practice manager were both helpful and also seemed committed to achieving the best possible outcome.  I made it clear I will change doctors if I decide I need to and she said she hoped I wouldn't, as she'd see it as a professional failure and she cares about providing a good standard of care.

The whole thing was bloody hard work. A bit like life I hear you cry! Well yes, maybe. Maybe that's just how things are. It could certainly have been worse.

The "Thursday Thursday Thursday...." thing is the sticking point. I said - "I need to know you hear what I'm saying, it doesn't work for me when you interrupt me", she said "I need to filter all the different things that patients say to me, identify what's important and respond to that, if you were to sit in front of me and just say Thursday, Thursday, Thursday I wouldn't respond to that because I would know that it wasn't important". Hmmm, if I'm saying something important and she's hearing it as "Thursday, Thursday Thursday", that's no good is it? That's no good at all. And I don't go to the surgery to say things that don't matter, my time is worth more than that.

Do I trust her judgement on what is "Thursday" and what is important? That, for me, is perhaps the crux of the matter. I recognise that she knows a lot more than me about mecicine and she acknowledged that I will know more about my condition than anyone else.  She said that she values my input in decision making, which is a good thing. Hmmm. The theory is that after clearing the air today we have built some mutual understanding and she will listen to me more in future, mind you she didn't actually say she would. The "Thursday" comment was possibly quite telling.

After the meeting I felt quite frazzled. My lovely husband gave me a big hug and a bar of chocolate and my Twitter friends rallied round, one tweeted me a beautiful oil  painting of a tranquil sea he'd just finished, another took me out for coffee and a flapjack - and brought me home made honey and freshly laid eggs too! People are amazing. I feel supported. I'm grateful for that.

I have some more thinking to do and will post again about next steps, when I've had more chance to reflect on what they're going to be....

How about you, ever complained? Ever switched doctor? Ever wanted to? Ever used the NHS Mediation Service, or posted your experience on Patient Opinion, or pursued any other avenues to make things better between you and your doc? I'd love to know. You can comment below if you'd like to, I'd love it if you did.


*My friend from twitter who kindly took me out for coffee today suggested we meet by the Halloween display in The Range, Westwood Cross, there's actually quite a nice coffee bar there and she had some business to attend to nearby. I thought the gruesome display was hilarious - and kind of apt for today's post - at least I'm not dead yet and I've got lovely friends and I can still have a laugh! 

Tips for communicating with your doctor (Guest Post)

I have been sent a wonderful guest post for this blog, by someone with some great advice for anyone having a difficult time engaging with their GP - who kindly wrote it up following an earlier article I wrote on here - where, amongst other things, I mentioned that I sometimes find my GP's communication style a little challenging to deal with. You can read that original post here (it has a great soundtrack too!)

A lot of the suggestions were things I think I already know and believe I am already doing, but there are some extra little gems in there too, things I might not have thought of before. Here are the tips I have been sent which you may also find useful:

Tips for talking to your doctor:

Just as you have off days, or are more emotional at certain times, so too your GP may experience similar.  She's human like everyone else.  So if she seems hostile put it down to her having an 'off' day.  But make a note of the day of the week and time of your appointment for future reference.

On next appointment, try starting the appointment by briefly asking her how her day has been going.  You'll get a sense if she's stressed or not, before launching into your health issues.  Also she might appreciate you asking her how she's doing, and so she'll mirror your attitude possibly for the rest of the appointment. 

If hostility continues at that 2nd appointment, double check afterwards if appointment week day and time is similar to last appointment - if so, then something might go on with her on that day and time frame each week and so make a note to yourself never to make appointments around that time frame in future.  If timing is different, then just note the day and week again.

On third appointment definitely pick a totally different day and time - maybe morning appointment.  Might be a bit of an inconvenience for you, but she might be fresher and not so worn out.  Start again by asking how she is doing before getting in your health issues.  If hostility continues, then mirror her posture.   So if her hands are folder, then fold yours, etc.  Then once you are locked in similar position, slowly start to relax your body and position of hands, arms, etc.  She will mostly likely subconsciously mimic you, and that may get her to relax.

One other thing, don't talk to her with arms folded or slouched.  It's subconsciously picked up by the other person that you are close minded and stubborn.  May or may not be true, but brain interprets it as a hostile position.  I personally like to sit with my arms folded, because it warms up my hands, and didn't realise how this might be interpreted.

I'm aware of this stuff because I've been on negotiation training courses where they give body language tips on face to face negotiations.  You can read some info about this here.   

A couple of other tips:

if hostility continues on third visit, bring someone along with you next time as an advocate (e.g. your husband or close relative like sister/brother/mother/father).  Just by having another person in the room, it might make GP a little more objective and less subjective.  Also if you interpret hostility, you can ask the person with you afterwards if they interpreted similar or not from GP.  You might find out their interpretation is different to yours, and because you trust them, you can talk openly with them about perceptions and maybe there's something you can communicate or think differently when with your GP in future.  If they agree GP is hostile, then consider changing GPs - you are the consumer after all.

 you might want to buy a voice recorder to bring with you to GP visit - assuming GP is OK with you recording the visit, then just switch it on during the visit.  This is good for 2 reasons - (1) you can concentrate on the visit and asking questions without getting distracted about taking notes on her advice which you can listen to later on at your leisure, and (2) you can listen to the appointment at a later time to see if your impression of hostility holds or changes (after a cooling off period you might find she wasn't hostile but it was something you incorrectly latched onto during the appointment)

get comfortable with silence and use it to your advantage.  Don't think you have to keep talking.  Ask a question, and then just wait for the GP to answer.  Sometimes they need 30-60 seconds or so to think and answer properly.  Don't rush that, just sit quietly waiting.  30-60 seconds will seem like a long time but it is only a minute or less.  If they ask a question to you and you need time to think it through then delay talking back until you've thought out your answer thoroughly in your mind, even if that means a bit of a delay when you answer. 

Another I learned about only a few years ago, but it's extremely powerful and really simple.  It's a male/female thing.  Men tend to talk in 'you' statements.  Women tend to say 'I' - problem with that is women tend say things like I have a problem, or I need help, etc.  Subconsciously the other party interprets that as they don't own this issue or problem.  But if you subtley turn your sentences into using 'you' then the other party will then subconsciously take ownership of the issue or find a solution.  I read about this in a book about managing workload.  I thought it was a bit of mumbo jumbo, but I was in a really desperate work overload situation with my boss so I decided to try it.  We'd had several conversations before but nothing ever changed.  What I did after reading that tip was outlined on paper all my work tasks, how many hours it would take to get them finished vs my normal work time, and then I handed the paper to my boss and asked 'what will you be doing about this?'  The topic about my work and tasks was not new but the response was totally different just by tacking on that last 'you' question - the response I got from my boss was he would take away my information and come back to me with a solution.  Two days later, he reassigned 25% of my work projects to someone else.  Absolutely amazing!  A couple of months later, my husband was having a problem with an unreasonable client who wanted more work done than what was originally agreed and without paying extra fees.  I told him about this 'you' tip, and he did similar - he outlined the options which were basically to pay more for extra requests or stick to the original brief and original costs.  He finished by asking 'what choice do you prefer' - the customer totally backed off and was much more reasonable after that.  I now tell everyone if you have to complain, or you are in disagreement with someone, try not say statements with 'I' - flip it around to incorporate 'you'
Last tip - practice the conversation you plan to have with your GP ahead of time - think through possible couple of ways she might respond (both good and bad from your perspective), and then think through how you might respond to each of those responses.  Just by visualising the conversation ahead of time in all it's various ways it might go, you'll feel more comfortable to handle whatever happens during the real appointment. 

(With many thanks to the guest author of this article who wishes to remain anonymous) 

This was one of the topics discussed at our May meeting in London and I hope to have notes from that session to share soon too. Watch this space! 

Thyroid Hope