A flow of feeling cannot occur if the doctor spends the whole time asking questions or giving advice, and he or she learns to allow the patient to choose the subject matter by a judicious use of open-ended questions and encouraging signs. Such an approach can take less time and is more appropriate to a primary care consultation than a traditional medical history. A simple example of the efficient use of time is to ask the patient how she feels about starting on the Pill. One trainee doctor spent ten minutes explaining in great detail all the thrombotic and cancer risks and benefits of the Pill while the patient’s eyes glassed over. When asked at the end what her anxieties were, she said she was worried about her future fertility. The doctor’s time could have been spent more profitably dealing with the patient’s anxieties rather than going through a required formula to which she was not listening.
During a short family planning consultation in general practice or in a clinic it will, of course, be necessary to ask some questions and to give some advice, but the timing of such activity is worth studying. Is it an appropriate moment to move on with the practicalities, or has the doctor escaped into ‘traditional doctoring’ because of some discomfort between doctor and patient? Noticing, thinking about and possibly commenting on that discomfort rather than running away from it can provide a further space for the patient to reveal hidden feelings.
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