Sometimes it feels like the consulting room is an ark, with the patients coming in two by two. Now of course I expect some patients to come accompanied; its quite difficult to share management options with a screaming baby
But when full grown adults come in with their mum, dad, advocacy worker, friend or just some random person, the whole dynamic of the consultation changes. My opening gambit has to soften from my usual warm greeting of “what the hell do you want?” to something a little softer. Once I have lit the litmus paper I then find the best option is to go and get a cup of tea whilst they decide who is actually going to tell me why the patient is littering my consultation room. This not only is a good use of the time between my opening gambit and getting any useful information and it also helps hide my irritation that the second chair has been pulled around to encircle me like a shark around its stranded prey
By subtle body language I try and actually engage the patient once the relative has embarked on their diatribe of whatever the patient has got the problem with. This subtle clue of refusing to make eye contact with the relative and sharing my eye contact between “The Guardian” and the patient with a ration of 3:1 respectively. A glance at the patient at the end of news article usually suffices.
Yet regardless of this approach, the relative is the most important person in the consultation. If they leave content with the outcome of the consultation then it is usually a nicely rounded off consultation, but if they don’t, then is the little nagging voice in my ear telling me that I did not meet their expectations. Sometimes the expectations are easy enough to meet such as referral to emotional crutches ‘r’ us counselling services or the panacea to having a shit life, fluoxetine. Other times it is just not reconcile what is possible with what responsibility the so called guardian of the patient is trying to palm off on me; For example, to re-house their offspring in a 10 bedded council funded mansion, or to wave my magic wand and suddenly cure the alcohol/drug/gambling addiction of the afflicted. The little voice of discontent usually takes the form of a torrent abuse and expletives.
It doesn't take long to get a barometer on the situation; a nodding head in the corner of my visual field and I get all warm and fuzzy inside. A cold icy stare boring into my temple, one which would make Medusa look like her gaze is a little flirting, usually alerts me to the fact that we are not on track and i either need to re-evaluate where i am going with the consultation or hold fast for a rocky ride ahead.
I have so much learned to enjoy the nodding in the corner of my eye that I now carry one of those nodding dogs in my black bag. You know the ones from the car insurance adverts. I have found that just positioning one of these in the corner of whatever consultation room i am working in makes me spend the whole surgery feel like at least someone, albeit it an inanimate object, has faith in me.