It’s not what you say as a GP. It’s how you say it. Lessons from a recent near miss...

I saw a female patient recently with a chronic severe mental health issue. Isolated after losing her partner. Only her pet for company.

I’d seen her a few times in the past and she said I was the only person who she felt listened to her. 

We got on well, despite her mental health making her life chaotic with multiple additional health concerns and untied threads for missed appointments. Some to rule out cancer.

I wrote back to the departments with whom she had cancelled appointments to rebook.

A few weeks on I heard that she’d cancelled all appointments again after a call with another clinician who had refused to give her nutritional drinks on prescription because she was “too fat”.

This encounter made her not only cancel her appointments, but even change surgeries.

It took me 5 minutes to call her back, calm her down, ask her to re-register, come back to see me and get things straightened out. 

I explained why she didn’t need the nutrition supplements right now but that we will monitor. 

I approached her with same respect as a family member, even if her request wasn’t something I could provide.

After this she revealed the reason she couldn’t attend her appointments was due to feeling scared and alone. 

Her community mental health nurse used to go with her but now due to staff shortages this isn’t possible.

She wasn’t being stubborn. She had just not mentioned this before.

I will see her again to reassess her symptoms and refer back for more support.

But it struck me that one rude encounter could have had life changing consequences for this lady. Missing these appointments can delay diagnosis and treatment.

Here’s the problem.

People with severe mental illness generally have poorer outcomes in health. They die earlier and live for longer with poor health and multiple conditions.

They can easily slip through the net, especially if they are reluctant to attend for fear of being spoken down to or insulted.

But it took 5 minutes to pay some respect to this woman and get her back on side.

If I hadn’t received the discharge letter she may have been lost to another surgery with less continuity, more delay and more difficulty.

So I ask my colleagues:

Are we checking in on the language we use?

Are we aware of the implications of rude encounters, however busy we are?

Do we feel we need to take more care with more vulnerable patients?

If the answer isn’t yes to all then we need to consider what we are in the business for.

I know my colleagues are overwhelmed right now. 

So we need a global push for efficient ways to communicate with respect whilst still managing high work loads.

I use Dr David Burns’ 5 Secrets of Effective communication framework but there are multiple out there.

Because without this, we’re certainly creating more work for ourselves and letting people slip who are in most need.

What do you think?