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Transcript – GP Consultations

Your GP is like­ly to be the health­care pro­fes­sion­al who’ll be most involved in help­ing man­age per­sis­tent pain, but it can some­times be a dif­fi­cult rela­tion­ship. Peo­ple in pain and their GPs both often feel that there isn’t enough time to deal with a prob­lem as com­plex as long term pain.

There is no ‘mag­ic pill’ for pain. As with any long-term con­di­tion – like dia­betes, for exam­ple – the best way for­ward is for peo­ple liv­ing with pain and their GPs to work togeth­er to man­age it.

Top tip: make the most of your next appoint­ment by not­ing down before­hand one or two things that you most want the con­sul­ta­tion to focus on.

Find out more: Pain Concern’s Man­ag­ing Med­ical Appoint­ments leaflet gives guid­ance on get­ting the most out of a consultation.

Dianne Con­nor: We’ve been brought up that if you have a headache, you take a parac­eta­mol. You’ve got an infec­tion – you go to the doc­tor who writes you a pre­scrip­tion for antibi­otics. When you have a pain, you go to the doc­tor, he gives you a painkiller. That’s how every­body believes pain should be dealt with. So I think there’s a huge edu­ca­tion prob­lem, from the patient’s point of view.

Gra­ham Kramer: All we’ve been able to focus on is the med­ical man­age­ment of peo­ple with long-term con­di­tions. And it’s very, very lim­it­ed. I think it’s cre­at­ing a huge bur­den of com­plex­i­ty, in terms of mul­ti­ple med­ica­tions and things, for people.

Con­nor: The one GP that does under­stand – she’s very good, but I can’t always get her, so I don’t go to the oth­er GPs who don’t understand.

Kramer: The evi­dence does sug­gest that it’s social­is­ing our patients into being pas­sive recip­i­ents of care. Or social­is­ing them into being in a rela­tion­ship of learned help­less­ness on the health­care system.

Con­nor: So if I go with anoth­er pain or some­thing strange going on and I can’t work out where my pain is com­ing from, I have to start at the very begin­ning, and in a 10-minute appoint­ment… [sighs] You’ve no hope.

When you’re diag­nosed with some­thing and have a chron­ic pain con­di­tion, you want the mag­ic pill! So some­body telling you – ‘well, basi­cal­ly you have an incur­able ill­ness and, by the way, you’ve got to man­age it your­self… Peo­ple would not take that in the begin­ning, that isn’t what peo­ple want to hear. But at the end of the day, that is the way for­ward; and it is the only way for­ward is to self-man­age your pain. And I don’t know how… I mean, that would have to be very clev­er­ly intro­duced to peo­ple, the way you tell peo­ple and when you tell peo­ple. ‘Cos everybody’s different.

Kramer: I think one of the dif­fi­cult con­ver­sa­tions I have with my patients is get­ting them to some sort of accep­tance, that I don’t par­tic­u­lar­ly have a solu­tion, but try­ing to be very pos­i­tive, that I think that there’s a lot that we can do to help. And that we could help by work­ing through this prob­lem togeth­er. And I think I want to empha­sise that it is very much… I see myself… and often a lot of my patients that I have – we have a very strong pos­i­tive rela­tion­ship any­way – so we can begin to use that and build on it, to try and work through the quite intol­er­a­ble suf­fer­ing that they’re experiencing.

Con­nor: I was at a meet­ing not last week, the week before, where there were two GPs there. And they were in the group that I was work­ing in. And their def­i­n­i­tion of peo­ple with chron­ic pain was the golfer who comes along, who’s the nui­sance patient, who plays twen­ty rounds of golf a week, who has hurt his knee because he’s play­ing twen­ty rounds of golf a week. I was shocked, because I was sat in this group and that’s how they deemed chron­ic pain – and I thought, ‘Thank good­ness you’re not my GPs!’ But I [also] thought that that’s very typ­i­cal, is chron­ic pain is [seen] as a nuisance!

Paul Cameron: It’s easy for me, work­ing in a pain clin­ic who has the lux­u­ry of time with patients, to be able to get a real­ly good under­stand­ing of that one par­tic­u­lar prob­lem. Where­as a GP may know this patient over a long peri­od of time, so they have the time in that regard, but in indi­vid­ual appoint­ments I think they have, on aver­age, about 7 min­utes! And that 7 min­utes is based around ‘Do they have some­thing real­ly seri­ous, as in life-threat­en­ing, or not?’ And after that I think it becomes very dif­fi­cult for them to actu­al­ly man­age pain.

I find, cer­tain­ly for patients with com­plex long-term pain, that it does require that degree of time to be spent with the patient, part­ly so the patient feels like they’re under­stood and lis­tened to. And I think when they go into a GP appoint­ment and then quick­ly back out again, they pos­si­bly don’t feel very well lis­tened to. And hav­ing spo­ken to GPs, I don’t think for one minute that it’s because they don’t want to, it’s just because they aren’t able to in such a busy clinic.

Car­men Mur­ray: GPs aren’t experts, you know, in cer­tain fields and obvi­ous­ly they have an over­all knowl­edge of med­i­cine, so it’s some­times try­ing to make them under­stand when you’re in pain how much pain you’re in. Like pre­vi­ous­ly – now I’m try­ing to reduce my painkillers – but pre­vi­ous­ly when I was in a lot of pain years ago when ask­ing for more painkillers. And you want to be able to, but you’ve got no way of prov­ing to them that you’re in so much pain.

Some­times you can sort of feel – I don’t know whether this is just a per­son­al thing – but, wor­ried that they’re sort of look­ing at you and ask­ing [them­selves] ‘are you just look­ing for more drugs’? And you nev­er want­ed to be in this sit­u­a­tion on your own, where you’re rely­ing on drugs just to get you through the day…

Cameron: We encour­age patients when they go to the GP to be clear about what they want to ask. But some­times they’ll go with the list. And the list is too long, the GP has to essen­tial­ly go through the list and almost pick out the ones that he or she may think are the most seri­ous ones – and that might not match what the seri­ous ones are to the patient, because they look at the list and think, ‘Okay… which one of these could indi­cate can­cer? Or some­thing [else] more serious’.

And the patient might think, ‘that isn’t what I want­ed you to look at, the most impor­tant one was at the top of the list’. And, of course, then you get that mis­match. But it’s a 7‑minute appoint­ment, so you can under­stand why these atti­tudes start to gen­er­ate –mis­un­der­stand­ings between the patient and the professional.

Mur­ray: There was one time when she asked me if I was get­ting pain in my legs. This was about a month before every­thing was found out. And I explained to her, ‘No, I’m not get­ting pain in my legs, but I’m start­ing to feel numb, they’re start­ing to feel real­ly numb.’ And her response was, ‘That wasn’t what I asked you.’

Cameron: I have to say, I was involved in a pilot in Arbroath in a GP prac­tice that was kind enough to let me invade their prac­tice and try to iden­ti­fy patients that might be at risk of devel­op­ing chron­ic pain, just through the med­ica­tions that they were tak­ing. And what I found real­ly was quite stark – and I didn’t appre­ci­ate it until work­ing with them – was just look­ing at their com­put­er screen: they had half an hour per patient, which I thought isn’t very long, because I’m used to a bit longer with my patients.

But then I saw the lists of the oth­er GPs in the prac­tice and I was just tak­en aback by the sheer num­ber they were see­ing in a day. And at that point I thought it real­ly made sense as to why patients feel like they’re not get­ting very much time and GPs feel like they’re rushed and they have to pri­ori­tise their appoint­ments. And they have to pri­ori­tise what they talk about dur­ing the appoint­ments, as well.

Kramer: I think we need to have more train­ing in hav­ing these dif­fer­ent types of con­ver­sa­tions with our patients. I went to a work­shop recent­ly – a group of very expe­ri­enced GPs – and we were look­ing at chang­ing the approach to the man­age­ment of peo­ple with dia­betes. The doc­tors found it very, very hard to change from their tra­di­tion­al role of being in con­trol. And they were try­ing not to be! They couldn’t help leap­ing in at cer­tain times and tak­ing control.

Con­nor: There was this meet­ing that I was at two weeks ago, where it was about the GPs in Fife to attend. And hard­ly any of the GPs I knew were there. So, I think, it’s like you can take a horse to water but how do you make it drink…?

They need to look at the whole per­son and try to under­stand this per­son – that this per­son isn’t a nui­sance, that this per­son needs as much time as the dia­bet­ic or some­body with cancer.

Mur­ray: I described the pain as much as I could. I was telling her that I wasn’t sleep­ing. I was pac­ing the room. I fell down the stairs at work because my legs were start­ing to go so weak, you know… I’m not real­ly sure how I could have explained it better.

Con­nor: We need the same time or understanding.

Mur­ray: What you want from your doc­tor is some­body who’s actu­al­ly lis­ten­ing to you.


  • Dianne Con­nor
  • Car­men Murray
  • Paul Cameron, Physiotherapist
  • Dr Gra­ham Kramer, GP


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