During the first appointment I spend 30 minutes with the patient on average. If the patient needs more time then I will spend more time, although I am aware that I don’t want to keep people for other appointments waiting. My aim for the first appointment is to try and take a full history from the patient, listen very carefully to the sort of prompts that my experience will guide me towards which will help me to make a diagnosis. I am trying to make that diagnosis throughout the consultation. I like to try and get patients to express their priorities. I am quite willing to accept that if a patient has carefully thought through my plans and options they might not necessarily decide to go in a certain direction and I will try and work with them to make the best of the treatments.
As a physician I see a number of different complaints of different types presenting in men and women, presenting in adolescents and in childhood. The treatments that I plan are on an individual basis. I plan those via the best evidence, the best treatment both nationally and internationally. I try to design the treatment according to both my views and the patient’s views and we try to work as a team.
What I like to try and do is guide the patient into a diagnosis that is as accurate as possible and during the consultation I use quite a number of prompts that I send the patients out with. So I write down what the diagnosis is, what the management plan is and what the future holds. Whilst trying to be reassuring I also have a practical approach and where medicines are necessary I like to try and guide people into the right sort of treatments. I work with a multi disciplinary team. I work with physiotherapists, occupational therapists and I also try to work with peoples families and partners, so I encourage them, when they come to their consultations, to bring someone they trust, who can be an extra pair of ears and listen to my explanation, and my experience whilst people can be very bright and switched on, when they are in a consultation environment they remember very little about what they are told as they are concentrating on getting all the messages across to me. I have a number of imaging technics that I can use and within the Runnymede Hospital where I provide my private practice we have a MRI scanner, a CT scanner, a bone densitometer for measuring peoples bone density, and plain normal x-ray facilities. We also have a team of muscular skeletal radiologists who can provide guided injections to difficult sites using ultrasound and x-ray guidance.