I'm sure it's nothing!
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Our consultation with Mrs Graham, a female patient, begins with her raising various issues. She hints early on that there might be a primary concern, saying, “Well, it’s several problems; I don’t know. It might just be one major problem.” However, she initially tiptoes around this primary problem and instead discusses her family’s issues.
At the start, Mrs Graham tells the doctor, “The Whole family seems to be going to pieces recently.” She might have started the consultation this way to show that it’s not just her that’s got problems at the moment. Next, Mrs Graham talks about her son, who had recently moved school, and his struggles with fitting in, from not being able to concentrate on having not made any friends. As a result, she believes the frequent illnesses he keeps getting are signs that he’s becoming run down and that something is worrying him. Due to the patient mentioning this, the doctor asks, “Sort of how old is he?” We discover he is 12 and coming up for the typical entrance age. At the point of the consultation, she could be using how the children are feeling to talk about how she is feeling herself, but she might be a bit run down herself.
Furthermore, Mrs Graham discusses her daughter, suggesting that she’s exhibiting typical teenage behaviour. She then hints at the possibility of a physical issue. It’s clear that the patient is using her family’s issues as a cover while also trying to address her own major problem, which prompted her visit to the doctor.
This could be worrying the children, too.
Lastly, Mrs Graham talks about her husband and how he’s become irritable from being passed over for a promotion at work. The doctor then asks, “Does he take it out on the family?” the patient thinks and mentions he does in a way as he’s never got time to talk to listen to the family. Therefore, she believes, “This could be worrying the children too.” She tells the doctor. At this point in the conversation, the patient lists problems the family members are having that she might be struggling with.
I feel physically run down myself.
Unexpectedly, Mrs Graham finally starts to talk about herself. We find out that the weight of these issues she’s been talking about of her family is causing her to feel discouraged, and she tells the doctor, “It’s getting me down. I feel physically run down myself. I wondered if, perhaps, I should have a Tonic!” Things could be better for Mrs Graham.
At this point in the recording, it is recommended to pause and begin a general discussion about the most appropriate course of action for the family doctor. The discussion should include prioritising the presented problems.
Rewind the tape.
After rewinding the tape, the scene continues with the family doctor paying undivided attention to the patient. In shock from hearing his patient’s wishes, the doctor inquires, “In what way does this seem to be affecting you?” Mrs Graham, with courage and vulnerability, reveals two reasons. The first is that she feels overwhelmed by her family. Mrs Graham cannot argue with them due to a lack of energy and inability to communicate. The second reason is that she has her own problem – she’s found a small lump in her breast. The doctor probes further by asking if this is worrying his patient, to which she replies, “I suppose it is.” The patient finally shared that the lump was the reason for her consultation visit.
At the end of the consultation, it is revealed that Mrs Graham has a lump in her breast. Initially, she hesitated to discuss it and used her family’s issues as a diversion. However, with his thoroughness and competence, the doctor addressed the problem and proceeded with an examination, ensuring that all the patient’s concerns were addressed.