Ideas, Concerns, and Expectations of patients

by Peter Tate - Date: 2007-01-08 - Word Count: 651 Share This!

For the purpose of this article imagine yourself being unwell. Think of waking with a severe sore throat, lots of large neck glands and feeling pretty ropey. Would you go to your doctor? If not what else might make you go? What questions do you ask yourself?

Let us go through some of your possible questions and answers:

1. What has happened? It's probably just a virus, Max had it last week.

2. Why has it happened? I've been working late, a bit overtired, resistance a bit low.

3. Why to me? Rotten luck but I always get these things, Max sneezed over me.

4. What should I do about it? Dose myself up with soluble aspirin and it should just go.

5. Is it serious? No it will be gone in a few days.

But what happens if the exams are two weeks away or there is a hockey trip to California next week?

1. What has happened? Maybe it is a streptococcus?
4. What should I do about it? I better see the doctor for some penicillin.
5. Is it serious? Yes if I fail the exam or if I can't make it to California.

Or what if your partner has glandular fever.

1. What has happened? Oh god it's glandular fever.
2. Why has it happened? Too much kissing.
3. Why to me? I had it coming, life has been too good recently.
4. What should I do about it? I had better see the Doc to do a monospot to confirm it.
5. Is it serious? Yes this could put me out for the rest of the year, I have also read it can cause Hodgkin's disease, oh my God!

These questions and answers can be translated into the trinity of ideas, concerns and expectations. To continue with the same example of the sore throat and glands scenario think of:

What ideas might be going through your head that first morning...... "I feel awful, really really bad, too bad for a cold, it must be at the very least flu. I bet I got it from Max he was coughing and sneezing all over me last week. It might be streptococcal so a trip to the doctor for some penicillin might help. I wonder if there is any left in the drawer that I didn't take last time? I will have to get some soluble aspirin"........etc

What concerns might be wandering through your brain? "Help, I hope and pray it's not glandular fever. If it is that's the exams down the tubes, and it can lead to Hodgkin's can't it? What if it's worse? I mean acute leukaemia can start like this. I have been worrying about my immune system for some time. I haven't caught AIDS from that dirty toilet seat have I? Don't be silly but it could turn into quinsy I think they call it, like that poor bloke in the other office last week. His tonsils were so big he couldn't breath. If I don't get this fixed pretty quickly next week's trip to California with the hockey team is finito." etc

What about your expectations?......"If I do nothing it will probably go away if I dose myself up, but penicillin is a good idea because it might speed things up especially with the hockey trip coming up. I expect the old Doc will just tell me it's a virus and I will have to lay it on a bit thick to get the penicillin. He might do a blood test for glandular fever. Shall I tell him I am a bit worried about AIDS? No he will think I am silly. I expect he will tell me off for smoking too." etc

This leaves us with a very important truth:

None of us goes to a Doctor with just a symptom.

We go with IDEAS about the symptom,
with CONCERNS about the symptom and
with EXPECTATIONS related to the symptom.

I will expand on these three givens in later articles.

Related Tags: communication, patients, expectations, patient, doctor, doctors, ideas concerns, your health

Peter Tate qualified as a doctor at Newcastle in 1968. After spells as a P&O Surgeon and as a trainee in Kentish Town he was a family doctor for 30 years. He was an MRCGP examiner from 1981; he retired as convenor of the panel of examiners in March 2006. He is the sole author of The Doctor's Communication Handbook now in its 5th edition. He is also the author of The Other Side of Medicine, a collection of essays and short stories. He has also recently published Seasickness, a novel based on his experiences as a young ship's surgeon. He was a co author of The Consultation and The New Consultation OUP. He has lectured widely on communication issues. His recent medical books are available from Amazon and Seasickness is also available from Peter has just written 3 books for patients available at:

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