The Consultation

Your visit to the doctor – “The consultation”

Most doctors offer routine appointment times of ten minutes. During this time the doctor will take a history (your story), examine you, discuss the possible causes for your symptoms, discuss treatments, possibly issue a prescription, arrange tests or referral and discuss any follow up arrangements (the “plan of action”). As you can see this is a lot to get through in ten minutes and this is only for one problem! 

Before your appointment

Things to consider before you see the doctor:

What do I want to achieve from my visit to the doctor?

Do I want a diagnosis, medication, reassurance, tests, sick note or is it a follow up appointment for an ongoing problem?

Sometimes the doctor has asked to see you, in which case it is likely to be for a medication review or for follow up of an ongoing illness.  

The History – “your story”

How to give a good history:

Each visit to the doctor starts with you giving your story or “history”. This is a very important part of the consultation, as the doctor will make a diagnosis on the history alone in about 60% of cases. It’s a good idea to spend a few minutes before you see the doctor thinking about your history.  A good time is in the waiting room before you are called in to see the doctor.

Useful things that the doctor will want to know are:

How long has the problem been going on?

Is it there all the time, or does it come and go?

If intermittent, can you describe how often it comes on and lasts for?

For each symptom some other details are very useful.

For example:

Pains:
  • Where is the pain?
  • Does it go anywhere else? For example if you have a pain in your back does it also travel down your leg?
  • For a problem that comes and goes, a record kept in a diary can be very useful to refer to, for example, with headaches.
  • Does anything make the pain better or worse for example movement, eating, taking deep breaths etc?
  • Are there other symptoms at the same time as the pain?
Chest symptoms:
  • Breathing: Do you have any shortness of breath or wheezing? What kind of exercise makes it come on, or is it present when resting? For example: on hills, going upstairs, or lying flat in bed.
  • Cough: Dry and hacking or chesty and wet (this means you are likely to be producing phlegm or sputum). If so what colour is it and how much are you producing each day?
Bowel (poo) problems
  • When and how have your bowels changed?
  • Have you passed any blood or mucous (slime)?
  • Have you also had tummy pains?
Urinary (waterworks) problems
  • Are you passing urine more frequently?
  • Do you have any burning or stinging?
  • Has there been any blood in the urine?
  • Do you have any lower tummy or back pains?

If you have a problem with your waterworks the doctor will almost certainly want to test a sample of your urine (wee). Try to remember to bring a fresh one with you in a clean container, or ask for a bottle at the surgery.

Psychological or Mental Health problems:

These usually take longer and it may be appropriate to make a double appointment (20 minutes) to see the doctor.

General symptoms:

If you are losing weight for no reason or having night sweats, these are important symptoms, so be sure to tell the doctor.

For each symptom the doctor will ask you further questions to clarify your history. When the doctor has taken your history he/she may examine you depending on the problem.

More than one problem – “I’ve got a list doctor”!

If you have several problems the doctor may not be able to deal with them all in one visit.

If you come with several problems or even a list, please give the doctor a very brief indication of each problem and which one you feel is the most important to you. The doctor can then decide which problems to deal with first.

If you have a particularly complicated problem or too many to deal with in one go, the doctor will ask you to come back for another consultation.

Sometimes patients think that because they only come to the surgery occasionally, the doctor is able to give them extra time. Unfortunately this is not the case, as it would mean that every patient that comes afterwards would have their appointment delayed and over a two-hour surgery this could lead to long delays.

The examination