Box 2.
: Doctor unaware of patients' views of medicines or of patients' anxieties about symptoms or treatment
- Patient 21
- Mr C is a 31 year old married man. He has suspected fibromyalgia syndrome, which causes pain in his joints. He takes a range of drugs including painkillers and amitriptyline. He is consulting to discuss his painkillers among other things
- Doctor 7
- Dr D is a male partner in a five partner rural practice
- Summary of misunderstanding
- Mr C has an appointment to see a rheumatologist in a few weeks' time. He intends to stop taking all his drugs a few days before seeing the consultant, but does not tell Dr D. Mr C is worried about taking too many painkillers. Dr D is unaware of this and thinks that he likes taking medicines
- Preconsultation interview with patient
- Interviewer: Right, okay. And do you think you will change any of your medication or ask to change it or ...?
- Patient: Mmm, not at the moment, he won't change it ‘cause erm he don’t want to up them up too much or I might get used to them and I might feel more pains and that. I'm trying to keep the painkillers down. I'd rather go with the pain a bit than be bumped ... too much pain and then get addicted to painkillers what's going to.... Once the painkillers, you're equal to the painkillers your pains are going to be there all the time anyway. So, he's trying to keep the painkillers under control
- Postconsultation interview with patient
- Patient: So what I'll do is—I wanna come off the painkillers for about—I've gotta see him on the 21st, so I'll probably come off them for about four, three or four, days so I can get my pains in my joints, so when I go to the s- see the er arthritis specialist then he could s- suss out what my joints are like
- Interviewer: Right, yeah. Mmm
- Patient: It's if—er without the painkillers—if I've got too many painkillers he can't assess what's in my—what my pains are like
- Interviewer: Mmm. Did the doctor tell you to do that or were you just doing it yourself?
- Patient: No, I'll do it—I'm gonna do it myself
- Postconsultation interview with doctor
- Doctor: I think he loves taking medicines actually. For a young man, 10 years younger than me, he's had more medicines than I've had hot dinners. So I can only suppose that he—he likes having them. Something which proves he's ill