Doctors ‘must reassure’ worried well to save time

'A significant percentage of patients spend hours with doctors every year'. Picture: Contributed
'A significant percentage of patients spend hours with doctors every year'. Picture: Contributed
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Doctors must get better at reassuring patients who frequently visit surgeries with their health concerns as the NHS struggles to cope with rising demand, doctors believe.

Recently concerns have been raised that some patients can visit A&E departments in Scotland as many as 50 times a year.

Writing in the BMJ, Glasgow GP Des Spence says the same is happening in general practices, with a significant percentage of patients spending hours with doctors every year.

He said rather than sending them on for expensive and unnecessary tests, doctors needed to get better at reassuring them they were well. He also called for more research into the situation.

Patients’ campaigners said GPs needed to be sure patients were well before they were dismissed from their surgeries.

In his BMJ article Dr Spence, of Maryhill Health Centre, said GPs’ waiting rooms were full of familiar faces, some attending more than 50 times a year.

He wrote: “GPs are criticised for having appointments that last only ten minutes, but we spend hours each year in the company of some patients.”

Dr Spence said these patients had “abnormal health-seeking behaviours and health anxiety” which were often passed down through families.

He said they often had vague and medically unexplained symptoms, such as fatigue, headaches and pains, which were “confusing, contradictory and exasperating for doctors”.

Dr Spence wrote: “The traditional medical model of care is spectacularly inadequate when dealing with frequent attenders, leading to needless referrals, investigations and, by sheer weight of contact, spurious labels and diagnoses. The only certainty is that investigation, referral and labels made frequent attenders worse not better.”

Dr Spence said this meant that the “medical art of doing nothing with style” was a core clinical skill. “I might refer frequent attenders for NHS homeopathy because patients receive care but without harm,” he wrote.

Dr Spence said research suggesting 3 per cent of patients generate 15 per cent of GPs’ workload seemed like a “gross underestimate”. “This is not just about wasted resources. These patients are also receiving harmful and poor medical care,” he wrote.