Keeping to the Comfort Zone
An understandable safety behaviour
Notice the GP's non-verbal behaviours here- the eyebrows, the facial expression that shows the underlying judgemental approach to the patient's disclosure. This is accompanied by the dismissive tone used when talking about 'the evidence for that side of things' and follows this up by putting forward the concern of potential interactions. His use of the word 'we' is coercive rather than collaborative. Notice the use of the word 'dangerous' in an attempt to persuade.
While the intention is to remain evidence-based, it's delivered insensitively.
The GP continues with use of the word 'we' to express 'what we'd be recommending' and this places the NHS GP profession on the other side of a line away from the patient- the language places her in opposition and understandably she could feel detached from the decision and control over her treatment choices.
Be careful that when you say 'we' that it's clear this is part of a shared decision. It's easy to spot when it's not.
SCA Feedback Statements
The persons agenda health beliefs and or preferences were insufficiently explored
The examiners felt the consultation was insufficiently person-centred.
It is important to understand the context of the illness; and attach importance to the subjective aspects of medicine. This means always seeing the patient as a unique person and being curious; then valuing patient preferences and expectations.
For example, a patient whose neighbour has lung cancer may have fears about their own cough. Another patient may be vaccine hesitant due to health beliefs which are understandable and strongly held in their community.
Suggestion
Ensure you explore the person's ideas, concerns and expectations; also consider the impact the situation has had on their life.
A judgmental approach was shown to the person
Examiners felt that you conveyed judgement about the person and/or their behaviour/situation in your response to them during the consultation. This may have been implied.
There are many ways a judgement can be expressed or perceived. For example, doctors may inadvertently ‘fat shame’ someone with obesity by implying ‘we get the body we deserve’; or comment ‘what did you expect?’ when a person becomes pregnant from unprotected sex. A person who has recently left prison may experience judgement when an unnecessary line of questioning about their crime ensues. Although reasonable challenge may be appropriate, criticism of parental decisions about vaccinations, food choices or smoking in the flat may be unhelpfully judgemental and therefore alienating.
It may be that people with certain protected characteristics generate a less empathic, supportive response. For example, an undocumented migrant may be only superficially helped or even dismissed.
Suggestion
We all carry unconscious bias. Recognise which consultations may challenge your assumptions. Understand why some people may be more vulnerable, more susceptible to illness or less able to make changes that improve health. Try to consult with a diverse range of people and demonstrate empathy, compassion and partnership with them all where possible.