‘Fobbed off’

I can’t bear this phrase. A few evenings ago, a newsreader on the BBC News used it when interviewing a GP and I visibly flinched.

We hear it as GPs all too often. Especially those of us that use social media and witness comments regarding health on various fora e.g. parenting groups. ‘Go to the GP and demand x! Don’t let them fob you off!’

Why does it rile me so much?

Probably because I don’t think that’s what GPs are generally intending to do; I certainly have never knowingly ‘fobbed’ anyone off in my whole career. I desperately strive to make sure my patients’ needs are met to the best of my ability and using the available (limited) resources as effectively as possible. I am also sad that these days our expertise is often not valued and respected in the way it used to be; patients are now much more aware of what might be available to them and many have a strong attitude of ‘entitlement.’ Frankly, the idea that a patient thinks I would ‘fob them off,’ I find utterly insulting, offensive and upsetting. Of course, GPs vary and I am probably particularly sensitive about this as I am someone who has spent a lifetime putting everyone else before myself; often to my own detriment. There is no way I wouldn’t try my best for my patients.

Why do patients use this term?

A different way of putting it into words (using ‘GP-speak’), is that their agenda has failed to be met. They do not feel their needs have been addressed adequately. They did not get what they hoped for from the consultation. Maybe they didn’t feel properly listened to, heard or taken seriously. Fair points; we as doctors must try harder to avoid this happening.

Are patients actually ‘fobbed off?’

Using the definition from the Oxford Dictionaries which I have put as the blog image, I would say this almost never the case; deceit is not usual! I am not aware of any GP that would deliberately fail to meet a patient’s needs.

But….clearly patients’ experiences sometimes do not correspond with this; they DO report feeling let down as if the GP has purposely not provided what they expected.

Where does this impression come from?

I think there are three main reasons why a patient would leave a consultation feeling this way.

Firstly, the fairly obvious one… The NHS has finite resources and is currently struggling more than ever. At practice and individual level, we have a responsibility to use these resources wisely, carefully and appropriately. However, most of the restrictions within day to day practice, are not decisions at this level but ‘rules’ that have been set from higher up in order to keep the NHS running safely; we are not always at liberty to provide what is expected. This is probably the reason that most patients think they do not get what they wanted i.e. financially driven. More often than not, this is not actually the case.

Secondly, what I consider to be the main reason. There are times when patients have a very clear idea in their own minds as to what is the right course of action. This may have come from family or friends, internet fora or ‘Dr Google.’ (Incidentally, I personally have no problem with patients researching their symptoms before attending, as long as they allow us to put this correctly into context.) Unfortunately, this can lead to some quite misinformed expectations. For example, somebody with low back pain expecting an X-ray (often pointless and an unnecessary dose of radiation). Then, of course, the dreaded antibiotic issue. For the majority of presentations, most of the diagnosis comes from the ‘history and examination’ (i.e. our professional assessment) rather than tests, but this is not well known by the general public. We have a responsibility to act in the most clinically appropriate way and put the best interests of the patient first; THIS is usually why we take a different course of action from what was expected.

Finally, the thing I am most passionate about; communication. We Brits are notoriously bad at this! We tend to be overly polite or even shy about just saying it how it is for fear of causing offence or being embarrassed. Therefore, as a health care practitioner, it can be hard at times to actually establish what the patient’s ‘agenda’ is. Sometimes, this is due to the patient being a little cryptic (for example, we hear some quite amusing names for body parts at times!) or just not feeling comfortable to say exactly what is on their mind for some reason. Other times, the doctor has not picked up on the ‘cues’ given or has not asked the ideal questions to draw out the relevant information; we are human after all and do not carry out perfect consultations every time. Since first publishing this blog, a friend described to me an unsatisfactory consultation she had; the GP suggested various things which they both knew (although this was unspoken) probably weren’t going to work and just time was needed. She would have preferred the GP had just acknowledged this rather than clutching at straws.

How to help avoid feeling ‘fobbed off’as a patient

• Respect your doctor: By all means, listen to others’ experiences of the same symptoms and do some of your own research, but please also respect the expertise of the doctor who has trained long and hard to learn this knowledge and skills; and continues to develop and refresh them all the time. They are trying to act in your best interests. The other thing is to remember that no two people are exactly the same and the right path for one person may not be the right one for you. You should not expect to ‘demand’ something from the doctor.
• Communicate: If the doctor is not offering what you thought you needed, tell them! There is nothing we won’t have heard before and are not easily embarrassed. We are also human and do not have superpowers that allow us to read minds; just tell us what you are thinking. If you feel the explanation given or the course of action suggested does not feel right (even if we are actually suggesting trying things, in our keenness to help, that sound unlikely to work!), we would rather know. We can then discuss it further; it may be that you are absolutely right about what should be done next once more information is available or you have portrayed how you feel. Or it might be that it is not appropriate and the doctor can explain the reasons to you. Sometimes, the plan may change just in order to allay your worries once you reveal what they are.
• Remember the financial context: Take a moment to remember your place in the ‘big picture’ of healthcare and the NHS. The money pot is only so big and is struggling. There is a balancing act to be done so we mustn’t use the resources frivolously. That said, I strongly believe that the NHS will provide what is actually necessary in a given situation. Along the same theme, try not to ‘take’ from the NHS if you don’t absolutely have to; for example, don’t push for prescriptions for simple medications that can be bought over the counter or acquired through the minor ailment scheme.
• Continuity: Try to get to know your doctor and stick to the same one whenever possible. Clearly, these days, with appointments hard to get at all, this can be pretty hard to achieve, especially for an urgent issue. But, if you can, developing a good doctor-patient relationship can help you tune into each other better which will enhance the interaction and make it more likely that you feel your needs are being met effectively.

I am aware that some patients reading this may feel I have been critical. However, I have been careful to make sure I am not tarring everybody with the same brush; I know the more negative comments do not apply to all patients by any means hence the use of words like ‘many,’ ‘some’ ‘often’ etc. I have also attempted to be fair and acknowledge the doctors’ part in patients feeling ‘fobbed off;’ we also must keep striving to do our best to improve consultations to avoid this.

I am hoping, above everything else, that this blog will be helpful. If you have anything you would like to add, please feel free to comment on social media or the website or contact me privately through the contact form; I would welcome constructive feedback. (Please do not be aggressive or nasty; I mean well!)

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