On the Frontline: GPs try to get balance of telephone and face to face appointments right

I want to help patients make the most out of their appointments. Today I will cover the examination.
Stethoscope - genericStethoscope - generic
Stethoscope - generic

By far the most important part of an appointment is the discussion. Examination plays a smaller role than many patients think. However it essential for building relationship, assessing if someone is unwell and at times for diagnosis.

Body language and eye contact builds trust and improves communication. There are also clues to diagnosis in the way that people move and facial expressions.

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Examination is often helpful to working out how unwell someone is. Much of this is done simply by seeing a patient come into a room. The ‘vital signs’ give further information; the heart rate, breathing rate and temperature.

Dr Ben Allen, Birley Health Centre. Picture: Chris EtchellsDr Ben Allen, Birley Health Centre. Picture: Chris Etchells
Dr Ben Allen, Birley Health Centre. Picture: Chris Etchells

The stethoscope, the distinctive tool of the doctor, only rarely changes my plan.

For example, sometimes parents come as they ‘want their child's chest listening to.’ I can tell with around 90% certainty in first 15 seconds if they may need antibiotics or an admission to hospital.

The story of the illness helps. Their appearance, heart rate and breathing rate is also key.

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It is very rare that ‘listening to the chest’ will change my plan.

At times examination is crucial for the diagnosis. If the discussion can only bring it down to two or three possibilities, the examination may make things clear.

GPs have worked differently in the last few years. Often we start by getting information over the phone. Many problems are managed quickly, safely and conveniently this way.

We may bring patients to be seen if the problem is too complicated, if someone is unwell, or the diagnosis is not clear.

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With General Practice under enormous strain, we have the challenge of balancing the number of appointments, with the efficiency of how we deliver appointments and the preferences of our patients.

The increase in telephone working has understandably led to anxiety from patients.

Face to face working does enable better communication and relationship building.

It can be useful to tell how unwell someone is and to help with the diagnosis.

GPs will continue to do their best to get this balance right.