In the investigation report on my son’s SI (Serious Incident), the authors have applauded the doctor for taking longer than 10 minutes on consultations and providing us with ‘reassurance’.
Both, seemingly good things.
Is the length of time spent on a consultation a good enough measure of the quality of assessment? Time is something we can measure, which is why we measure it. It has no bearing on the quality of a consultation. Did the appropriate conversation take place? Were the salient features of the type and severity of illness correctly assessed? In someone who is severely depressed was a proper risk assessment for suicide made and a safety plan put in place? Was the family made aware of the seriousness of the illness if they were expected to take care of the patient at home? If the patient had presented with a mental illness, were the concerns of the carers listened to? Was the effectiveness of current medications evaluated? Was a specialist referral deemed necessary?
Does the time spent on a consultation in any way indicate the ability of a doctor to deal with a problem when all he has to offer at the end of it is ‘reassurance’? No one is expected to know everything about everything and that is why we have telephones. We can remotely ask for help and opinions. It is easy to do. When I have a tricky case that is what I do. When I have trainees with me I actively encourage them to ask for help if they have the slightest doubt. It does no harm.
The old version of the Hippocratic oath says:
“Practice two things in your dealings with disease: either help or do not harm the patient.”
The modern version says:
“I will not be ashamed to say “I know not,” nor will I fail to call in my colleagues when the skills of another are needed for a patient’s recovery.”
So, while ‘reassurance’ may seem to be comforting, it can be terribly misleading. The patient’s and carer’s best interests lie with the acknowledgement of the truth, followed by appropriate action.