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Encouraging patients to self care

Explaining symptoms will help patients cope better with future minor illness. By Dr Paul Stillman.

The most important starting point for the practical implementation of self care is to explore the situation from the patient's perspective. How do they view their illness, its severity, expected duration and any fears arising from it? A four-day-old cold is a problem if the patient believes it should get better in three days.

Roughly 20 per cent of my consultations raise a minor illness issue. I know the rate would be higher if our practice had not invested considerable time developing relationships with our patients and, more importantly, taken the time to understand their personal agendas. I know of GPs who are immensely frustrated by constant requests for prescriptions but refuse to see the value in taking the time to explain why a prescription is not necessary.

Mothers and grandmothers
Evidence from international research strongly confirms that mothers and grandmothers are the main determinants of health and illness behaviour in families. Therefore to improve self-management of minor (and major) illness it is the mothers and grandmothers we need to target.

In our practice we work hard with young mothers to help them understand how best to look after their own and their children's health, sometimes reversing patterns of behaviour of 20 years or more.

For example, I have a young mum whose own mother had brought her in as a child every year with 'her annual tonsillitis, doctor', which she believed would only get better with antibiotics. Based on her own experience, the young mum began to bring in her children every time one of them had a sore throat.

Relationship of trust
Once we explained that most cases of tonsillitis are viral - and proved this to her by examining the child's throat over three visits and taking a swab where necessary, we developed a relationship of trust.

I was able to explain and demonstrate to her that unless the child had some clear clinical signs of a bacterial infection (pyrexia, pus in tonsils, and so on) antibiotics would be ineffective. I told her it would be better for her daughter if she was cared for at home, helping her symptoms and recovery with liquid paracetamol.

Now, not only does she manage her children's sore throats herself but she has educated her mother and sisters and improved their management of sore throats. Therefore a small investment has had an exponential benefit for my patient, her family and the practice.

Congratulating self care
I usually start a minor ailment appointment by finding out what the patient has done so far and make a point of congratulating sensible - and appropriate - self treatment, even if it is not for long enough.

I tend not to let medical jargon and why medication is necessary take over consultations. I do my best to set a realistic expectation around the normal duration of the illness, normal symptoms and treating them.

We give knowledge to patients as appropriate and see doing this as an investment. It yields substantial gains in better patient/doctor relationships, reduced minor illness consulting and earlier recognition by patients and carers of atypical and serious illness.

Enabling accurate and meaningful conversations between patient and doctor about listening to and addressing patients' real concerns surely is the foundation of excellent care.

  • Dr Stillman is a GP in West Sussex and a member of the Self Care Campaign advocacy group

Help patients to help themselves

  • Explore the situation from the patient's perspective.
  • Acknowledge their success, such as managing fever and 'doing the right things', even if they have not persisted for long enough.
  • Avoid confusing medical jargon, reinforce use of home medicines rather than writing prescriptions, and do not give inappropriate reassurances.
  • Give a realistic expectation of the natural history of the illness, its symptoms and duration and help patients recall similar previous experiences.
  • Help patients feel more confident by telling them you are available to review the illness if its severity or duration strays from the normal agreed path.
  • Reinforce the advice with positive messages and by summarising the expected course of the illness and how to treat the symptoms.
  • Avoid conflict: just keep telling the patient what to expect and do.
  • Bear in mind that research shows around a dozen consultations are needed to effect change.

 

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