Thursday, 10 December 2009

Yours or mine?

Sometimes it can be pretty hard to know where my responsibilities start and finish when it comes to patients. Take Martin, who was worried that he might have thyroid disease. Having read on the internet about the symptoms of tiredness, weight gain and low mood (average British person in mid-winter?) he made an appointment to get some bloods taken. We discussed that he should telephone in 3 days time for the results, but as often happens, he never did. Should I call him?

David obviously thinks so. He came in for a repeat prescription this week and in passing mentioned that he had never found out the results of a blood test taken over a year ago; 'I assumed if there was something wrong the doc would have called me'.

Actually, there's no real question that checking test results is a doctor's obligation. After all, if we're not interested in the results, why bother doing the test in the first place? But at the same time, I do find it a little frustrating if a patient doesn't also check for themselves. It's largely because it increases my work load but it's also because it gives the impression that by coming to see me they have absolved themselves completely of all responsibility for their own health.

Another example is that of Mr Shaw. His problem was of food sticking in his throat when he tried to swallow. This was worrying, and so I referred him to a specialist straight away. I explained that he needed to telephone to make the appointment himself but on checking my outstanding referrals a few months later I saw that he had never done this. Despite the fact that we had discussed a plan which he had understood and agreed to, he had not followed the instructions. So should I chase him up? Is that my responsibility? (In this case I did, and I'm sure you'll be pleased to know that his symptoms have resolved)

Of course there's no black and white answer here and in practice what you do and don't do for your patients comes down to how worried you are about their symptoms and what you can realistically achieve. It just isn't possible for any one doctor to keep tabs on all of their patients all of the time. There are too many uncertainties: Are they attending appointments? Are they picking up prescriptions? Will they come back as I asked them to? With thousands of patients on your list, these questions will inevitably often go unanswered.

To some extent then, you have to be able to rely on patients to be accountable for themselves, to take back some of the responsibility. This isn't a risk free strategy. There are always going to be situations when there is a mismatch of expectations between patient and doctor and in these circumstances there is a real danger that something important could get missed. Fortunately for me it seems that on the whole my patients are worryingly well versed on the fallibility of doctors (...must have been the one before me...) and so, with a bit of teamwork, we seem to be doing pretty well.

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