WEBVTT - What to know when dealing with your GP with Dr Preeya Alexander 0:00:09.320 --> 0:00:12.000 Hello, I'm Francesca Rudkin and I'm Louise Area. And this 0:00:12.080 --> 0:00:14.760 is season four of our New Zealand Herald podcasts The 0:00:14.800 --> 0:00:18.040 Little Things, a podcast where we have common sense conversations 0:00:18.120 --> 0:00:21.080 about women's wellbeing at all ages and stages. 0:00:21.640 --> 0:00:24.360 And today we are going to take a close look 0:00:24.560 --> 0:00:28.160 at someone we see a little or a lot, depending 0:00:28.760 --> 0:00:32.000 on that age and stage. So a GP visit can 0:00:32.040 --> 0:00:34.479 be as simple as a fifteen minute appointment to establish 0:00:34.560 --> 0:00:37.199 maybe if you saw throat, who's a viral or bacterial infection, 0:00:37.720 --> 0:00:40.040 But it is sometimes a start of a long and 0:00:40.120 --> 0:00:44.960 difficult pathway of diagnosis and treatment and hopefully recovery for 0:00:45.040 --> 0:00:48.800 anyone of gosh many illnesses and injuries that could befall us. 0:00:49.440 --> 0:00:51.080 I mean, how many times have you got we're not 0:00:51.080 --> 0:00:52.320 going to go because they're just going. 0:00:52.240 --> 0:00:53.320 To tell me it's viral. 0:00:54.000 --> 0:00:56.920 Oh well, yeah, that's true a lot all the time. 0:00:57.960 --> 0:01:00.920 But that's finally sunken now and she's right and it's 0:01:00.960 --> 0:01:01.960 all been okay, touch. 0:01:01.840 --> 0:01:04.080 Work, that's right. So the GP is our go to 0:01:04.200 --> 0:01:06.399 when something's up for us or obviously I loved ones 0:01:06.480 --> 0:01:09.199 and I think Francisca we're both been quite lucky. Our gp' 0:01:09.200 --> 0:01:11.720 has been with us for many, many years. Yeah, like 0:01:11.760 --> 0:01:15.160 pre kids, through the reproductive years and beyond. 0:01:15.319 --> 0:01:17.560 I think I was twenty five when I started going 0:01:17.560 --> 0:01:17.880 to my. 0:01:18.080 --> 0:01:20.119 Think you know I was about to say, yeah, yeah, 0:01:20.160 --> 0:01:20.800 I started. 0:01:20.520 --> 0:01:23.039 Going to my GP. She's not loved to retire until I. 0:01:23.240 --> 0:01:25.440 The thing, right, they're going to retire, They're probably going 0:01:25.480 --> 0:01:27.080 to be older the last one we start seeing them. 0:01:27.120 --> 0:01:29.600 So at some point mine did retire. But I was 0:01:29.640 --> 0:01:32.320 really lucky because she had a daughter who's a GP 0:01:32.640 --> 0:01:35.679 who talk over her practice and she's divine, so that 0:01:35.760 --> 0:01:38.080 comfort and continuity is something with you know, a lot 0:01:38.120 --> 0:01:39.959 of us have had in our GP, and it's a 0:01:39.959 --> 0:01:42.280 relationship though that we still might take for granted. I 0:01:42.280 --> 0:01:43.479 think at times, Look. 0:01:43.360 --> 0:01:45.000 I've been pretty lucky in my life. I haven't had 0:01:45.000 --> 0:01:47.520 to go to the doctor an awful lot. But I 0:01:47.560 --> 0:01:50.520 think since hitting peri menopause, I've come to value my 0:01:50.560 --> 0:01:54.880 doctor even more because there's just so many mysterious aches 0:01:54.920 --> 0:01:59.960 and pains and symptoms that are more than likely peri menopause, 0:02:00.880 --> 0:02:03.600 but you shouldn't just presume they are, Like, it's really 0:02:03.640 --> 0:02:06.640 important to still make sure it's not something else. And 0:02:06.680 --> 0:02:09.400 that's something that my GP is very open to and 0:02:09.520 --> 0:02:13.440 very good at you know, she'll treat everything seriously and 0:02:13.440 --> 0:02:15.800 won't just sort of say, oh, that'll be agent stage. 0:02:16.000 --> 0:02:20.280 Inevitably it is just agent stage, which is good, Which 0:02:20.320 --> 0:02:22.040 is good, But I do worry that she might be 0:02:22.080 --> 0:02:24.600 getting a little bit sick of me, now, you know. 0:02:24.600 --> 0:02:25.640 I mean we do. 0:02:25.800 --> 0:02:28.280 Every single guest we've had it's talked about menopause has 0:02:28.720 --> 0:02:32.359 really reiterated that go if it's something that's bothering you, 0:02:32.360 --> 0:02:34.040 you know, it still might be something you can get 0:02:34.160 --> 0:02:34.960 some relief from. 0:02:35.080 --> 0:02:36.560 Of course, your GP was with. 0:02:36.520 --> 0:02:39.600 You when you would well you know, she was very 0:02:39.639 --> 0:02:41.600 much with you when you were diagnosed with breast cancer. 0:02:41.680 --> 0:02:44.160 Yeah so she which is yeah, she's a major, she's 0:02:44.200 --> 0:02:46.079 your first person. Right you go to hear you you're 0:02:46.120 --> 0:02:47.600 hoping she's going to say what you want to hear. 0:02:47.639 --> 0:02:49.600 And she did. She said, this is too big to 0:02:49.600 --> 0:02:53.320 be a chairman, this is a sist. But she did 0:02:53.360 --> 0:02:55.440 see me on the right clinical pathway anyway from Mamma 0:02:55.440 --> 0:02:57.079 GRAMM and ultra sound, which I was only just do 0:02:57.280 --> 0:03:00.720 for and then yeah, we're not too about out to 0:03:00.720 --> 0:03:02.919 be a big mean tripling itt of tumor. I was 0:03:02.960 --> 0:03:05.400 a bit cross with her, which was not fair, you know, 0:03:05.440 --> 0:03:09.400 shooting the messenger, But we were genuinely both a bit devastated. 0:03:09.520 --> 0:03:11.840 I mean, imagine she had to tell me, you know, 0:03:12.120 --> 0:03:15.160 forty four mother of three. Absolutely, it was just horrendous. 0:03:15.680 --> 0:03:17.400 But I remember her face as we discussed it, and 0:03:17.440 --> 0:03:19.880 it was clear that the diagnosis was a surprise to 0:03:19.919 --> 0:03:22.400 her too, so so our GPS can still be surprised. 0:03:22.760 --> 0:03:25.080 She sent me on the right clinical pathway so fast 0:03:25.200 --> 0:03:28.480 my head spun, and as awful as it was, having 0:03:28.480 --> 0:03:30.000 here in my corner was invaluable. 0:03:30.280 --> 0:03:32.440 And I presume that you know, as you go through 0:03:32.480 --> 0:03:36.000 that journey, you're engaging with lots of different specialists along 0:03:36.000 --> 0:03:37.800 the way, but you still come back to your GP, right, 0:03:38.080 --> 0:03:41.080 you still come back. That's that's that person that's there 0:03:41.240 --> 0:03:42.440 in the long run for you. 0:03:42.480 --> 0:03:44.480 And she still came back to me. You know, she'd 0:03:44.560 --> 0:03:46.400 check in with me, she'd given me a call or 0:03:46.400 --> 0:03:50.080 send me a message or something. And you know, that's 0:03:50.120 --> 0:03:52.720 the genuine joy of a good relationship with your GP. 0:03:52.960 --> 0:03:53.600 Absolutely. 0:03:53.840 --> 0:03:55.440 And the thing about GPS is I might be able 0:03:55.480 --> 0:03:56.760 to you might visit and they can to tap you 0:03:56.800 --> 0:03:58.000 on the spot and off your head home and you 0:03:58.000 --> 0:03:59.840 don't think about things again, or you end up on 0:04:00.240 --> 0:04:02.040 the kind of health journey like you went on, lou 0:04:02.760 --> 0:04:04.520 But they really are there for us in the best 0:04:04.840 --> 0:04:07.400 and worst of times. But do we really understand their 0:04:07.480 --> 0:04:10.240 role in our well being? And do they understand us 0:04:10.280 --> 0:04:11.600 and what we expect or. 0:04:11.600 --> 0:04:12.880 Want from them. 0:04:12.920 --> 0:04:15.120 It might be a bit of a mystery to try 0:04:15.120 --> 0:04:17.839 and answer these questions, though, we as well as pick 0:04:17.880 --> 0:04:20.560 her brain for some health advice. We've invited a GP 0:04:20.839 --> 0:04:24.080 A general practitioner, Doctor Preyer Alexander, on the pod today. 0:04:24.320 --> 0:04:28.000 Doctor Preyer is passionate about sharing accurate health information. I've 0:04:28.000 --> 0:04:31.320 listened to a lot of her podcasts. She hosts the 0:04:31.480 --> 0:04:34.280 Happy to Health podcast, and she's the author of a 0:04:34.320 --> 0:04:37.800 couple of books. Dr Preyer Alexander, thanks for joining us today. 0:04:37.960 --> 0:04:39.000 Thank you for having me. 0:04:39.520 --> 0:04:43.120 So prayer on researching today, it became clear to us 0:04:43.160 --> 0:04:45.760 that general practice is probably a little bit more complex 0:04:45.839 --> 0:04:50.120 than we fully realized. You know, having years and years 0:04:50.120 --> 0:04:53.240 of having visited one, I still was surprised at some things. 0:04:53.240 --> 0:04:55.640 When I was doing a bit of research, I was 0:04:55.680 --> 0:04:57.839 ready to fire off lots of general health questions and 0:04:57.880 --> 0:04:59.640 we will get to some of those. But first, if 0:04:59.680 --> 0:05:02.120 we could like just a bit of a view of 0:05:02.120 --> 0:05:05.720 what general practice is, Like, what do you want people 0:05:05.839 --> 0:05:08.960 to know about general practice and seeing the doctor? 0:05:09.120 --> 0:05:12.480 Where to begin? And I'm glad you said that because 0:05:12.520 --> 0:05:14.239 I think a lot of people don't realize the breadth 0:05:14.320 --> 0:05:17.800 of what we do. I think it's important to say 0:05:17.800 --> 0:05:22.880 that GPS do literally everything. So that's why I entered 0:05:22.880 --> 0:05:25.400 the profession, because I kind of wanted to not give 0:05:25.480 --> 0:05:29.600 up on pediatrics or older patients or preventative medicine. And 0:05:29.680 --> 0:05:33.599 so where's GPS. We'll see children. We do six week 0:05:33.680 --> 0:05:37.080 checks postpartum for mum and baby. We do vaccinations for 0:05:37.160 --> 0:05:41.240 all age groups. I look after them parents then their parents, 0:05:41.320 --> 0:05:46.160 so you know, grandparents, people with osteoporosis, dementia, diagnosis. I'm 0:05:46.160 --> 0:05:50.560 supporting people through fertility, journey, through pregnancy, through miscourage, through 0:05:50.680 --> 0:05:55.000 termination of pregnancy. I'm talking about contraception and bone health 0:05:55.080 --> 0:05:59.080 and bow cancer. So we do everything. I think that's 0:05:59.120 --> 0:06:01.880 what I love people to know that we are the 0:06:02.080 --> 0:06:04.640 experts in kind of everything, and we know a little 0:06:04.680 --> 0:06:07.640 bit about most things, and if we need help, we 0:06:07.680 --> 0:06:09.760 can always call it in and refer you to a 0:06:09.839 --> 0:06:13.400 non GP specialist. But we're also the people who do prevention, 0:06:14.160 --> 0:06:18.040 Like there's no one who does preventative medicine like GPS, 0:06:18.080 --> 0:06:23.120 where they're preventing dementia, preventing heart disease, preventing breast cancer, 0:06:23.200 --> 0:06:25.560 cervical cancer. We're doing the screening test, We're talking to 0:06:25.560 --> 0:06:30.520 people about diet, physical activity, you know, stress management, all 0:06:30.520 --> 0:06:33.280 of this stuff. And so it really is such a 0:06:33.400 --> 0:06:37.279 rewarding but incredibly exhausting job. I love it, but we 0:06:37.320 --> 0:06:39.640 get to see everybody. I never know what's coming through 0:06:39.680 --> 0:06:42.960 the door, which keeps it very exciting. But often I 0:06:43.000 --> 0:06:44.600 have no way and I say to patients, I don't 0:06:44.640 --> 0:06:48.480 know what this is. I know it's not terrible. Let's 0:06:48.480 --> 0:06:50.120 catch up in four to six weeks and see how 0:06:50.160 --> 0:06:52.120 things have moved. But we just we don't have all 0:06:52.120 --> 0:06:53.920 the answers. But that's what keeps it exciting. 0:06:54.600 --> 0:06:57.200 So, Priya, I'm not very good at going to the GP, 0:06:57.279 --> 0:06:59.159 and by the time I get there, I tend to 0:06:59.200 --> 0:07:03.200 have a couple of things on my list. So how 0:07:03.200 --> 0:07:04.960 do you feel when people walk kind and go I've 0:07:04.960 --> 0:07:06.279 got a little bit of a list for you. 0:07:07.440 --> 0:07:10.080 Look, I think it's good because it means the patient's 0:07:10.120 --> 0:07:11.920 thought about it before coming into the consulting room, and 0:07:11.960 --> 0:07:15.040 there's actually research that suggests people do a lot of 0:07:15.080 --> 0:07:17.880 planning and thinking before they come and see us. The 0:07:17.960 --> 0:07:20.880 thing with a list is honestly as a GP, if 0:07:20.920 --> 0:07:23.080 you've got a couple of things, book a double give 0:07:23.160 --> 0:07:26.280 us time to actually work through the list and give 0:07:26.360 --> 0:07:29.280 the problems the time they need and deserve. Sometimes I 0:07:29.280 --> 0:07:31.000 say to people, and it's few too many things for 0:07:31.000 --> 0:07:33.240 a single console. I think we need to put these 0:07:33.320 --> 0:07:36.760 really priority things on for today and let's delegate issues three, 0:07:36.840 --> 0:07:38.920 four and five to another console if you're happy to 0:07:38.920 --> 0:07:42.280 come back with the list. What I tend to do 0:07:42.360 --> 0:07:44.640 is the GP. And this is what you mentors have 0:07:44.640 --> 0:07:46.560 suggested to me through teaching, is I try and get 0:07:46.600 --> 0:07:49.040 it off you. So when you say I've got a list, 0:07:49.080 --> 0:07:51.280 I go, Can I hear the list before we even 0:07:51.280 --> 0:07:53.120 get into it. Can I get the list and write 0:07:53.160 --> 0:07:56.840 it down? Because sometimes what you've done is you've gone, 0:07:57.280 --> 0:07:59.520 this is really important to me. But the chest pain 0:07:59.560 --> 0:08:00.960 that I've been having on and off, I'm going to 0:08:01.040 --> 0:08:03.400 mention that at the end, Whereas I want to know 0:08:03.400 --> 0:08:05.559 about the chest pain first and put it to the top. 0:08:06.120 --> 0:08:08.880 And so you might find the GP kind of going, oh, 0:08:08.960 --> 0:08:10.920 can I hear the list first before we get into 0:08:10.920 --> 0:08:12.960 all the nitty gritty And that's because we're trying to 0:08:13.880 --> 0:08:17.600 triarge and time manage and there's so many things going 0:08:17.600 --> 0:08:19.680 through our brain that I just want that list so 0:08:19.760 --> 0:08:21.080 I can figure it out. 0:08:21.200 --> 0:08:22.040 Do you know what? That is? 0:08:22.160 --> 0:08:23.680 So true with that list. 0:08:23.720 --> 0:08:25.200 There's been a couple well, there's been things on it 0:08:25.240 --> 0:08:27.080 which I didn't think were all that important, and I 0:08:27.160 --> 0:08:28.360 might have just thrown it in at the end of 0:08:28.400 --> 0:08:30.640 the not went oh okay, maybe you should have started 0:08:30.680 --> 0:08:33.240 with that, and I'm like, oh, oh okay, sorry about that. 0:08:34.040 --> 0:08:35.760 I'm the opposite. I don't make a list and then 0:08:35.800 --> 0:08:37.920 I go for what it was acute, and then I 0:08:37.960 --> 0:08:40.440 walk out and go, oh, man, I should have mentioned that. 0:08:40.920 --> 0:08:43.600 You know, so this can be good because then you 0:08:43.640 --> 0:08:45.679 don't forget those little things like patients will go on 0:08:45.760 --> 0:08:48.000 my list. I've got cervical cancer screening. I'm up to date, 0:08:48.000 --> 0:08:49.960 and they go, no, you're not. Let's get that up 0:08:50.000 --> 0:08:51.240 to date. Let's tick that one off. 0:08:52.080 --> 0:08:53.360 Some of them will be easy, some of them will 0:08:53.360 --> 0:08:57.040 be harder. I've heard you talk about the Golden Minute 0:08:57.559 --> 0:08:59.640 in terms of gpre pratics. Can you tell us what 0:08:59.679 --> 0:09:01.720 that is and how why it's important. 0:09:02.600 --> 0:09:06.720 I can now it's definitely not my thing. The golden 0:09:06.720 --> 0:09:10.760 minute is described in research and my mentor Dodor Andy Morgan, 0:09:10.760 --> 0:09:14.560 who's an amazing GP now retiredly came on my podcast 0:09:14.600 --> 0:09:16.400 to talk about the Golden minute and it changed the 0:09:16.400 --> 0:09:19.560 game for lots of people listening. But essentially, it's that 0:09:19.679 --> 0:09:23.880 minute where you come into the consulting room and you 0:09:23.960 --> 0:09:27.520 get out the crux of the issue. It's the first 0:09:27.720 --> 0:09:34.760 minute and ideally it should be uninterrupted with empathetic listening 0:09:34.840 --> 0:09:37.440 from the GP, with kind of eye contact nodding, but 0:09:37.559 --> 0:09:44.079 no verbal interruption ideally, and it's a really powerful minute because, 0:09:44.400 --> 0:09:48.040 as Andy describes it, it really gives you the crux 0:09:48.280 --> 0:09:50.959 of the issue. Most of the time after the minute 0:09:50.960 --> 0:09:54.760 of the patient going I've had this lightheadedness. It tends 0:09:54.800 --> 0:09:57.440 to happen when I get out of bed. I've noticed 0:09:57.480 --> 0:09:59.640 it for about three weeks since the weather's been warmer. 0:10:00.600 --> 0:10:03.600 In that minute, I'm going, this is postural hypotension due 0:10:03.640 --> 0:10:05.800 to a weather change because it's hotter, and probably a 0:10:05.840 --> 0:10:09.959 bit of dehydration. So it's very powerful for the practitioner 0:10:09.960 --> 0:10:12.080 because we get all these little bits and bobs, but 0:10:12.120 --> 0:10:14.520 it's very powerful for the patient because they feel heard, 0:10:14.640 --> 0:10:19.079 uninterrupted and they get their time. And so yeah, that 0:10:19.280 --> 0:10:21.480 is the golden minute. But if you look at studies, 0:10:21.520 --> 0:10:23.719 most of the time patients get interrupted within about I 0:10:23.720 --> 0:10:24.880 think it's eighteen seconds. 0:10:25.320 --> 0:10:27.120 Yeah, because I mean you think about it, it's only 0:10:27.160 --> 0:10:30.360 one fifteenth of a consult, right, you know, it's really 0:10:30.400 --> 0:10:34.400 not that much time. But the patient feels seem heard 0:10:34.440 --> 0:10:38.520 and listened too. And I guess my thing is, yes, 0:10:38.559 --> 0:10:40.560 So if we're not getting that, if we're going to 0:10:40.600 --> 0:10:43.520 our GP and they are typing away or not looking 0:10:43.559 --> 0:10:45.960 at us, what can we do as a patient? 0:10:47.840 --> 0:10:49.720 Well, I think you've got options. I think if you 0:10:49.760 --> 0:10:53.240 feel comfortable enough and it takes some courage, I can 0:10:53.320 --> 0:10:54.640 understand that. And you need to have a good enough 0:10:54.679 --> 0:10:57.440 therapeutic relationship. You can say, hey, you know, I really 0:10:57.440 --> 0:11:00.319 feel like I need a little bit more here, do 0:11:00.360 --> 0:11:02.920 you mind if we just talk this through before you 0:11:02.960 --> 0:11:06.600 start typing? So sometimes you could actually talk to the GP, 0:11:06.679 --> 0:11:08.920 and I think often the GP might go I had 0:11:08.960 --> 0:11:12.880 no idea, So this teaching might not be across the board. 0:11:12.920 --> 0:11:15.600 Maybe the GP hasn't heard about it or other health professional. 0:11:16.320 --> 0:11:18.560 The other thing is if you you know, I think 0:11:18.600 --> 0:11:21.280 if you're going into a consult and you're having this 0:11:21.320 --> 0:11:23.240 thing where you're going, I don't think I'm being seen 0:11:23.240 --> 0:11:25.840 and heard. I don't feel like, you know, this is 0:11:25.880 --> 0:11:29.000 my safe place. I'm leaving the consulting room not feeling 0:11:29.120 --> 0:11:32.360 very validated. Maybe with more questions that are unanswered, you 0:11:32.440 --> 0:11:35.520 can try another GP. I think people are really nervous 0:11:35.559 --> 0:11:39.680 to do that, and we don't mind. We don't mind 0:11:39.720 --> 0:11:43.040 if you don't see another GP. Feel empowered because I 0:11:43.120 --> 0:11:45.760 have tried four or five until I've landed on someone 0:11:45.760 --> 0:11:48.520 where I go this person treats me not like a doctor, 0:11:48.559 --> 0:11:51.360 and actually, you know, treats me like a patient. It's 0:11:51.400 --> 0:11:53.280 taken me four or five to get Then I don't 0:11:53.280 --> 0:11:55.080 feel guilty. I'm like, no, you're not the one for me. 0:11:55.120 --> 0:11:57.520 You might be fantastic for other people that you're not 0:11:57.559 --> 0:11:59.480 the one for me, So don't feel guilty about it. 0:11:59.480 --> 0:12:01.240 You don't need to say to the GP, just sltting 0:12:01.280 --> 0:12:03.720 you know. I'm going to go and just go for it. 0:12:03.800 --> 0:12:06.320 Ask your friends who do you see? What's the consult like? 0:12:06.400 --> 0:12:09.200 Do they listen to you? Are they typing away? What's 0:12:09.240 --> 0:12:11.960 the consulting room like? All those things, ask your friends, 0:12:11.960 --> 0:12:13.480 go and try a few options. 0:12:13.679 --> 0:12:16.960 It's interesting you say that because I moved and I thought, gosh, 0:12:17.040 --> 0:12:18.840 I need to find a GP. Maybe that's a little 0:12:18.840 --> 0:12:20.760 closer to home for my children when they were young. 0:12:21.240 --> 0:12:21.880 So I did that. 0:12:21.920 --> 0:12:24.400 I went and got all the recommendations. Every single doctor 0:12:24.440 --> 0:12:27.080 I got a recommendation for I rang those clinics and 0:12:27.120 --> 0:12:31.320 the lists were shut, and you were like, oh, you're joking. Okay, 0:12:31.480 --> 0:12:34.040 so you know, I sort of a bit stuck. 0:12:34.360 --> 0:12:38.240 I know that's Look, it's a tricky one. Often the 0:12:38.240 --> 0:12:41.040 people that are being highly recommended are after so it 0:12:41.080 --> 0:12:43.960 makes it difficult sometimes though, So if you go online 0:12:44.000 --> 0:12:45.760 to book with me, the books are shut. But I 0:12:45.800 --> 0:12:48.400 do have other avenues in which people can get in. 0:12:48.800 --> 0:12:52.800 So I think call the practice manager or reception and 0:12:52.880 --> 0:12:54.840 just ask, you know, does it look like they're taking 0:12:54.880 --> 0:12:57.320 any new patients? How do new patients get on the books? 0:12:57.400 --> 0:12:58.880 You know, is there a month that the books are 0:12:58.880 --> 0:13:01.480 going to open? Because there are off and things happening 0:13:01.520 --> 0:13:03.240 behind the scenes. But you've got to make the phone call. 0:13:03.520 --> 0:13:05.480 And I suppose you could also say to them, hey, look, 0:13:05.559 --> 0:13:07.560 is there another GP there who could see me, who 0:13:07.640 --> 0:13:09.600 works in the same way and sort of has a 0:13:09.640 --> 0:13:13.720 similar I don't know approach to practice as the doctor 0:13:13.760 --> 0:13:15.240 I wanted to get into. I suppose you just have 0:13:15.280 --> 0:13:16.600 to keep asking questions, don't you. 0:13:17.000 --> 0:13:18.800 Yes, you do. That's what I do, though, I would 0:13:18.840 --> 0:13:20.520 ask them, is there someone who's similar, because at my 0:13:20.640 --> 0:13:24.440 clinic there is a GP who's quite similar, you know, 0:13:24.520 --> 0:13:26.680 not identical, but you know, I say to my patients 0:13:26.679 --> 0:13:28.120 if I'm not here, this is the person I would 0:13:28.160 --> 0:13:30.480 go and see. And a lot of patients got, oh, 0:13:30.559 --> 0:13:32.720 I really like them. Some people will move there. They're 0:13:32.720 --> 0:13:34.640 easy to get into. I can get in on the 0:13:34.720 --> 0:13:36.280 day with my kids because I don't tend to have 0:13:36.280 --> 0:13:38.960 that on the day availability. So yeah, I think that's 0:13:38.960 --> 0:13:41.440 a great way to do it, to ask if there's 0:13:41.440 --> 0:13:43.480 someone kind of the same ILK. 0:13:43.920 --> 0:13:46.719 Certainly within our practice it's hard to see sometimes it's 0:13:46.720 --> 0:13:49.920 hard to see your primary providers. So depending on what 0:13:50.040 --> 0:13:53.280 the issue is, if it's a pretty straightforward thing, you know, oh, 0:13:53.960 --> 0:13:55.679 it doesn't matter who I see in the practice, that 0:13:55.760 --> 0:13:58.800 ethos is kind of similar, and I know that they'll 0:13:59.120 --> 0:14:01.840 refer back if there was anything else. I was diagnosed 0:14:01.840 --> 0:14:05.960 with breast cancer two thousand and craky sixteen and it was. 0:14:06.040 --> 0:14:07.800 It was terrible shock for my GP as well as 0:14:07.840 --> 0:14:10.280 myself because it wasn't what she was expecting it to be. 0:14:10.440 --> 0:14:13.960 But when the real tough thing for somebody is waiting 0:14:14.160 --> 0:14:16.520 for results, right, And I've also heard you talk about 0:14:16.559 --> 0:14:20.400 the power of time, and my surgeon also like there 0:14:20.440 --> 0:14:22.280 may or may not be a time where we will 0:14:22.320 --> 0:14:24.360 have all the information. How do you manage that with 0:14:24.440 --> 0:14:27.840 a patient? Because the anxiety is off the charts. 0:14:27.920 --> 0:14:31.240 It is. And I'm sorry to hear about your diagnosis, 0:14:31.240 --> 0:14:34.280 but you're so right that the you're okay. 0:14:34.000 --> 0:14:39.360 Now, she's good, one boot down, but I'm good, You're good. 0:14:40.520 --> 0:14:47.440 Look that uncertainty, that time waiting can be incredibly anxious, 0:14:47.760 --> 0:14:50.960 confusing time for patients. And I've got a couple of 0:14:51.040 --> 0:14:56.000 patients who've been through very tumultuous, traumatic weights. You know, 0:14:56.160 --> 0:15:02.440 waiting for the amniocentesis result is a congenital abnormality in 0:15:02.480 --> 0:15:06.160 this baby that is going to be life changing. Waiting 0:15:06.200 --> 0:15:10.120 for genetic results, you know, do I hold the same 0:15:10.240 --> 0:15:13.840 genes as my mother? And will I need to have 0:15:13.920 --> 0:15:17.600 a mastectomy and a hysterectomy, and I'm of childbearing age. 0:15:17.680 --> 0:15:21.600 Waiting weeks for those results, weeks or like you would 0:15:21.600 --> 0:15:24.240 have had, you know, waiting for your biopsyr results. This 0:15:24.640 --> 0:15:26.480 isn't this and it takes time, and you're going, how 0:15:26.520 --> 0:15:30.360 does the pathologist take that long? It is And I 0:15:30.400 --> 0:15:34.160 actually see patients in that anxious waiting time, and I 0:15:34.280 --> 0:15:38.320 just focus on all the strategies that we have to 0:15:38.640 --> 0:15:42.080 try and help the brain, you know, manage the stress. 0:15:42.120 --> 0:15:45.240 And it's nothing sexy or fancy. It's like, you know, 0:15:45.400 --> 0:15:48.600 can we be out in nature, physical activity, reduce the caffeine. 0:15:48.640 --> 0:15:50.520 Are we getting any sleep? Can I support you in 0:15:50.520 --> 0:15:52.840 any other way? Can we bring the brain to the 0:15:52.880 --> 0:15:54.920 present so it's not ruminating on what if, what if? 0:15:55.000 --> 0:15:56.760 What if? And going on, oh my gosh, what did 0:15:56.800 --> 0:15:58.920 I do to cause this? How I cause the cancer? 0:15:59.400 --> 0:16:01.000 How do we bring the brain to the presence of 0:16:01.120 --> 0:16:04.960 mindfulness meditation using apps? And I just say to patients, 0:16:05.080 --> 0:16:08.880 let's not enter the black hole. Let's just stay here, 0:16:09.680 --> 0:16:11.720 and let's just not go into the wad if black 0:16:11.760 --> 0:16:14.040 hole and just look straight in front of us, which 0:16:14.080 --> 0:16:17.080 is we just need to survive till tuesday, and on 0:16:17.160 --> 0:16:19.440 Tuesday we have that appointment for the results. It's just 0:16:20.120 --> 0:16:23.160 baby steps, and some of my consults are just supporting 0:16:23.200 --> 0:16:24.800 people through that. It's not easy. 0:16:25.040 --> 0:16:28.360 It's that whole thing about saying, you know, if there's 0:16:28.360 --> 0:16:29.640 nothing to worry about, don't worry. 0:16:29.680 --> 0:16:30.600 We'll worry about something. 0:16:30.640 --> 0:16:31.320 When we have. 0:16:31.720 --> 0:16:34.200 Something to worry about, you know, we have the information. 0:16:34.320 --> 0:16:36.800 That's when we can we can start worrying and also 0:16:36.880 --> 0:16:39.920 start doing something about it. And I wonder too, if 0:16:39.920 --> 0:16:42.760 it's really difficult for patients who feel like there is 0:16:42.800 --> 0:16:45.360 something wrong but we can't get to the bottom of it, 0:16:45.840 --> 0:16:48.920 and they're coming to a GP for a diagnosis and 0:16:49.560 --> 0:16:51.520 not really getting anywhere. You know what I mean, you 0:16:51.560 --> 0:16:53.440 could do what you mentioned there is go and get 0:16:53.960 --> 0:16:57.040 a second opinion. What advice do you have to those 0:16:57.080 --> 0:16:59.960 patients who really feel that there is something in miss 0:17:00.160 --> 0:17:02.360 but can't quite we can't get to the bottom of it. 0:17:03.320 --> 0:17:05.520 That's tricky, and I think you need a really good, 0:17:05.840 --> 0:17:09.800 strong GP in your passenger seat where you on a 0:17:09.840 --> 0:17:13.800 journey like that, someone who can nut it out with you. 0:17:13.880 --> 0:17:16.399 And sometimes when you can't get to the bottom of 0:17:16.440 --> 0:17:18.479 a problem. And again my mentor talks about that on 0:17:18.520 --> 0:17:20.920 my podcast about some there are some problems with no bottoms, 0:17:21.160 --> 0:17:24.159 some problems just we just never quite figure out that 0:17:24.200 --> 0:17:26.000 tingle in the left hoole on a Tuesday. I just 0:17:26.840 --> 0:17:30.560 I can't pinpoint it. And so for some people, the 0:17:30.560 --> 0:17:32.919 reassurance of this is nothing nasty. I don't know what 0:17:32.960 --> 0:17:35.320 it is, but I've excluded all the nasty things is enough. 0:17:35.480 --> 0:17:37.840 For some it might not be. But I think having 0:17:37.880 --> 0:17:40.639 a really strong therapeutic relationship with the person in the 0:17:40.640 --> 0:17:43.120 passenger seat, the GP on the journey is important. You've 0:17:43.119 --> 0:17:45.680 got to trust them, You've got to feel validated and heard, 0:17:46.240 --> 0:17:49.359 and you're right. Second opinions can be really important. It's 0:17:49.400 --> 0:17:52.199 not uncommon for me to say it or patient I 0:17:52.280 --> 0:17:55.000 reckon it might be worth seeing another GP here because 0:17:55.080 --> 0:17:57.880 I'm feeling out of my depth. I know, I don't 0:17:58.000 --> 0:18:01.440 know if I've got the kind of crux of this issue. 0:18:01.880 --> 0:18:05.720 And a fresh set of eyes can be incredibly powerful. 0:18:05.760 --> 0:18:09.120 And it's not a slight on me. You know, I 0:18:09.200 --> 0:18:11.919 don't have all the answers, and sometimes my mind is 0:18:11.960 --> 0:18:14.680 on one track and I go I didn't even think 0:18:14.720 --> 0:18:17.600 about ankializing spondelitis for this back paint. Thank goodness, I 0:18:17.640 --> 0:18:20.280 got a fresh set of eyes, because that's changed the 0:18:20.400 --> 0:18:23.760 whole journey here and we've actually got you know, interventions 0:18:23.760 --> 0:18:26.879 now that are yielding benefit. But look, I would say 0:18:27.200 --> 0:18:29.240 it's not easy for people who've got kind of a 0:18:29.280 --> 0:18:31.760 constellation of symptoms where you're going, I just want to 0:18:31.760 --> 0:18:33.800 put my finger on it. I'm just acknowledging that it's 0:18:33.840 --> 0:18:35.720 not always easy for either the patient or the health 0:18:35.720 --> 0:18:37.400 professional trying to support you. 0:18:38.480 --> 0:18:40.000 Do you get as worried as we do when you're 0:18:40.040 --> 0:18:41.400 running behind on a consult? 0:18:41.920 --> 0:18:45.879 Yes, so I do. Yesterday I ran what thirty minutes? 0:18:45.960 --> 0:18:49.840