The Consultation

In February 2021 the Chair of the Royal College of General Practitioners (RCGP) ,Prof Martin Marshall said we should be concerned about the replacement of the GP / Patient relationship with remote consultations.  The online consultation is necessary at the moment but should not ultimately replace the traditional face to face consultation. Prof Marshall made this comment in his opening address at the start of the RCGPs two day virtual conference in February. That shift to remote consultations, by phone or video, underlined a trend towards the “dilution or loss of the relational element of general practice”, Prof Marshall argued.

“The established literature tells us that telephone consultations tend to be shorter, cover fewer problems, are characterised by less data gathering, less advice, less rapport building, and are perceived to be less safe than face-to-face ones,” he said.
“We don’t want to turn the clock back; we know that remote consultations have a role to play in the emerging general practice landscape – some patients prefer them, and so do some GPs.
“But, if there’s one thing I’ve learnt during the course of the pandemic, it’s that it’s much harder to build a relationship with a patient, to establish trust and empathy, through a remote consultation.

I quite agree with Prof Marshall, the face to face consultation is vital in understanding how and why a patient has developed an injury. Without that personal connection, without knowing the person behind the symptoms, it’s harder to do my job, and help my patient to the maximum.

My consultation starts in the waiting room, greeting your patient is important and starts to establish a healthy rapport. How well did they get out of the chair, negotiate the one step up into my consultation room. Writing this blog I found an article ‘The effect of Physician Behaviour on the Collection of data (1984). They found that it took only 17 seconds to interrupt the patient talking about their problem. Allowing the patient to explain how the injury occured is vital in understanding not only ,how I can get them better, but to stay better also.  Other important information I need to know is

• any history of any previous injuries
• how you work / spend your average day
• hobbies
• Sports you may participate in, and how you train.

This is because,

• We are all different, and have different lives
• most injuries are the result of an accumulation of strain

knowing my patient makes it much easier to find the real reason they developed a problem and how best to treat it and prevent it.