Inside the physician mind

I am often asked what makes a European style of family medicine so different and particularly the sort of mental processes that I am using or trying to use in a consultation.

Its easy to think of medicine as a highly specialised form of science and whilst that’s true its in some ways to miss the point. Medicine is also about communication and of relevance to this issue of To Your Health its about Health Promotion and Prevention and helping people “Spring to Health”.

Many patients are anxious or worried about seeing a doctor, particularly for the first time so greetings are important, especially across cultures or language barriers. Those initial moments of greeting are important, the pain of backache shows on the way from the waiting room as does the avoidance of contact by someone who is depressed. For me its important to know something of my patient’s past medical history - some have said that medicine is like a story, a living narrative - and also some lifestyle issues about smoking, drinking alcohol, excercise and the health of family members, especially parents. I also like to know about my patient’s work and their families.

None of this is of direct relevance but it gives us both a chance to get on the same level of communication and gives me lots of important information which may or may not be relevant to their problem but can often be used at the end of the consultation to improve health. Perhaps the patient came with a bad knee but knowing that both his parents died early of heart disease is already reminding me that we should check his cholesterol and try and minimise the risks of this. Perhaps a female patient mentions she soon wants to start a family so I know I can offer some pre-conceptual advice.

Illness is very much a personal thing and I always try to get an idea of how it effects people and how they cope and what they are worried about, sometimes I’ll ask questions such as “What do you think it is?” or “What are you worried about?” The answers often expose their beliefs about health and their worries and help me understand the context of the problem. As we talk my brain is quickly scanning my patient against the last 200,000 I have seen, an amazing and yet generally accurate process carried out by the right (non logical) side of my brain - are they a bit anaemic, do they sound a bit depressed, do they look low on thyroid and so it continues all whilst I am listening to the story and comparing it with many others I have heard.

Of course weight and blood pressure are measured and recorded and by the end of the consultation there are always opportunities for health improvement. Its my job not only to respond to the patients real problem but also to broker aspects of preventative care to help them improve their overall health or that of their families. Usually there is an opportunity for something that can improve health. The time spent in the initial stages of the consultation and care with communication skills all help the family physician to enable patients to consider health improvement and to “Spring to Health”.

Friday, 17 June 2011

My new articles:

Pharmacies show contrast between Ukraine, West

Surviving Ukraine’s winter

Elderly in Ukraine

Surrogacy

Allergy

all articles of my blog | blogs of all doctors