When any patient walks into my consultant room I give myself two minutes. Two minutes to assess, to listen to understand and to plan. By the end of that time I know what is to happen next. All discussion after that point is, to put it bluntly, superfluous. I have a second voice, a moderator in my ear. The moment I hear repetition, an utterance making a reappearance, a piece of information that has already been communicated the moderator immediately shouts, 'time is being wasted'. Time is something I do not have. The ten-minute consultation is an art form. It needs to be slim, efficient, and utterly to the point. Too often it is flabby, excessive and without direction. My patients know what to expect when they enter my consultation room.
So when Mr Johnson, a patient well known to me, took his seat beside my desk I knew what needed to be done before he'd removed jacket. He was a good man. Hard working and thoughtful. He was also overweight, hypertensive and diabetic. He was a man doing his level best to engineer a heart attack. It was very clear to me the form this consultation needed to take.
Today, however, there was a fly in the ointment. He wasn't alone. I've never been entirely comfortable with 'extras' in the consultation room. A second pair of eyes, another brain, another style of body language to interpret. More variables when there's already too many. Today Mr Johnson was joined by his wife. She sat just out of my eye line. All of a sudden a three minute consultation had the potential to balloon.
She sat in silence as I discussed her husbands dangerously high blood pressure and appalling diabetic control. Mr Johnson nodded as we pressed on. All the while I could feel her in the room. She had something, that was clear, but what I had no idea. Mr Johnson and I flirted with the notion of him taking some exercise and, perhaps losing weight (both knowing it would never happen) and still she sat not saying a word. I summarised with my usual 'doomsday speech', in the hope that this might flush her out. I said 'Just so that we're all singing from the same song sheet. I'm very concerned that if we don't get these things under control you may have a heart attack or a severe stroke. Which may result in long term disability or, even, death.' Still not a squeak! Rarely do I get frustrated. I had half a mind to say, 'out with it,' so obvious was it that she had something to say. In the end I turned back to my computer screen. Mr Johnson stood and put his started to put his coat on. The consultation was over.
I almost leapt out of my seat when I felt a gentle tap on the shoulder.
'There was one more thing Doctor,' it was Mr Johnson's wife. Her face inches from mine. I noticed she was shaking a little.
‘It’s just, well you know. We had a little chat before we came to see you. We’d like to know your opinion on something.’
I had no idea what she was going to say next. She made a funny little cough then spoke,
'How often should we be doing it? He says three times a week, but I think that's a bit too much.'
I caught myself smiling, something I rarely do in consultation. 'Once a week is more than adequate.' I said.
'See,' she said pinching her husband’s nose. 'I told you the Doctor would say that.'
They smiled at each other and left the room.