The Rules (for GPs)

With respect to Dr Moderate who was forced to moderate his own rules.

With respect also to the Velominati Rules for cyclists, which Dr Moderate and I fully endorse. On reflecting upon The Rules, I realised that they were for the cognoscenti by the cognoscenti. Rule #5 is essential if you are to respect Rule #70, important in cycling, but they have no place in general practice, where cooperation, not competition is ‘The Rule’. I taught myself to use a cut-throat razor in order to adhere to Rule #33.

As a GP I aspire to the rules below:

Rule #1. Do not consult in a bow tie. Ever. You are a GP.

Rule #2. Do not consult in lycra.

As a GP trainee back in 2000 I arrived at work in my lycra after a brisk cycle-ride into work and opened my bag and took out a freshly ironed shirt and realised to my horror that I had forgotten to bring any trousers. My surgery was starting in 10 minutes and it was about 25minutes ride home. I wore my shirt, black lycra tights and brown ankle boots for the entire surgery. To make matters worse, my consulting room was upstairs and my patients had to follow me up them. Unsurprisingly several of them said that whatever it was that was wrong with them when they made the appointment had got better while they were waiting.

Rule #3. Tidy your desk.

Do not consult from behind a mountain of paperwork. If you are a real GP, you will obviously have a mountain of paperwork, but don’t have it all over your desk. It makes it very hard to blame the hospital for the missing letter or x-ray result when your own filing is obviously in disarray.  It makes you look disorganised and unprofessional. Hide it behind the printer instead.

Rule #4. Clean your kit. Do not perform earwax transplants.

The little plastic funnels that fit on the end of otoscopes (the torch for looking in patients’ ears) are disposable. You might be doing your bit for the environment by reusing them, but in the grand scheme of resource-depletion and climate change, it’s simply not worth peering through Mr Smith’s waxy deposits when you’re trying to look at Mrs Jones’ ear drums. And it’s disgusting.

Rule #5. Tool yourself up. Do not use a ruler as a tendon hammer or a bike-light as an otoscope.

Not so long ago my practice invested in wall mounted otoscopes and opthalmoscopes (for looking in ears and eyes). The difference between these and my old battery-powered kit was vast. For a few months before this I had taken to using my bike light to look at my patients tonsils, which was bright enough to light up heads like pumpkins, but far better than my battery-powered otoscope which was no better than peering in with a match. Rulers and the edge of the bell of your stethoscope are unacceptable alternatives for a tendon hammer. Both hurt and on occasion break. Furthermore time spent looking for kit while your patients are waiting is unprofessional and wasted.

Rule #6. Dr. is enough. The long list of letters after your name doesn’t impress your peers or make sense to your patients.

A diploma in contraception you picked up in 1984 is of no relevance to anyone. If you are a professor or have won a gong, good for you, but it doesn’t make you a better GP. A four-foot name plate with a dozen or more letters after your name  makes you look vain and insecure.

Rule #7. Don’t refuse anything, even homeopathy until you have heard the patient’s story.

If the patient’s opening line is a request and your response is a refusal, you’ve ruined the consultation. The correct response to a request for a referral for chiropractic is a look of interested concern followed by, “tell me all about it”

Rule #8. Your consulting room is not your den. It should be filled with neither religious paraphernalia nor boastful evidence of your fecundity.

Patients may not share your religious convictions and they may be struggling with infertility. If you must have pictures of your family, they are so that you don’t forget what they look like, because you are always at work. I know one GP who keeps a picture in a draw and for patients who ask, she shows them. I keep a couple of pictures on my computer.

Rule #9. Do not fear dependency.

Patients sometimes need someone to lean on. It’s your job to be strong when they are weak. Fear of dependency has de-humanised the profession. Related to this is continuity of care. Take responsibility for your own patients, get to know them, build up a therapeutic relationship. Ever jot of evidence shows that healthcare is safer, more efficient and more compassionate when you are looking after your own patients.

Rule #10. Do not bullshit your patients.

There is no excuse for guessing. If you don’t know, patients can look it up, on their smartphone. Very quickly. Admit you don’t know everything. Up to 40% of symptoms that present to doctors defy medical explanation.

This is a somewhat ‘off the cuff’ list, compiled on a cycle ride home from work. I expect to edit it on the basis of your wonderful contributions.