How to make the most of a visit to the doctor

Aspirations for a healthier body and mind will be behind many a New Year resolution, in the hope of increasing zest for life and reducing risk of illness.

For some, self-imposed lifestyle changes such as “dry” January, cultivating a porridge habit or taking the first steps towards running a marathon may be all it takes for improved wellbeing. Others, whether in search or prevention or cure, will need the help of health professionals.

In this, the first of an occasional series of user guides to our 2020 health services, Health + Family looks at how to make the most of a visit to the GP.

1) Ask yourself, do you really need a GP appointment?

It might sound a bit ironic that the Health Service Executive (HSE) is running a "think before you access health services" campaign but it wants patients to do a bit of triaging of themselves and consider self-care before looking for a GP appointment. Check out the advice at undertheweather.ie and mychild.ie, or visit your local pharmacy for suggestions of over-the-counter remedies. Common illnesses such as cough, colds, sore throat and earache are usually caused by a virus, in which case antibiotics won't help. Self-care and a bit of patience should get you through.

Working out on an empty stomach may have benefits

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‘I’m just going to come out and say it: small babies are boring’

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My 11-year-old is too anxious to sleep by himself

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I’m not a mother. Please don’t judge me

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Even if it has been a while since your last visit, there’s probably no need to schedule a new-year check-up with your GP if you are in the full of your health, not on medication and not worried about anything specific.

"If you're well and your lifestyle is good and your family history is good, what are you hoping to find?" is the response of the medical director of the Irish College of General Practitioners (ICGP), Dr Tony Cox, to the idea of an annual check-up.

However, he says, if you do have a symptom and have been putting off mentioning it to a doctor, “please come in”. Cardiac disease “is just too prevalent”, with pain or breathlessness being possible indications.

2) Keep “out-of-hours GP” for an emergency

The family doctor service that operates at night and at weekends is for acute illness rather than the convenience of the patient. Very young and older patients need to be prioritised out of hours, so if more people keep their less acute complaints for daytime GPs, who are likely to know them better anyway, there will be a quicker response service when you really need it.

3) Consider the costs

Anyone under the age of six or over 70 can attend a GP free of charge, regardless of income. The Government plans to extend this to children under eight from September 2020. If you are between those ages and don’t quite qualify to join the more than 1.5 million people who have a means-tested medical card, you may be able to avail of a GP visit card for which there are slightly higher limits for eligibility as regards income and savings. Otherwise, private patients must pay whatever their chosen GP charges because practices are free to set their own fees.

These vary from surgery to surgery and region to region, on average ranging between €50 and €60 per standard consultation, but going up to €70 in more upmarket urban areas. Then there may be extra costs for various tests and services on top of that.

All GP practices must openly display a full list of charges, so price information should not be hard to come by. However, not all include full details of fees on their websites – if they have a website. It could be worth shopping around if you don’t have an established relationship with a GP that you want to continue or have moved to a new area.

A few surgeries run membership schemes, where a flat fee covers GP consultations and other services such as blood tests, flu vaccination and writing of letters etc. For example, at Union Quay Medical Centre in Cork, members pay €17 a month.

Those with private health insurance may be able to recoup some of the cost of GP visits back, depending on their choice of policy. If you expect to be racking up GP visits, find out which health plan might offer the best cover for such “everyday medical expenses”.

For example, VHI has a range of plans that include benefits for GP visits, ranging from €20 for three visits per year up to 75 per cent cover for unlimited visits for GP services.

Half of Laya Healthcare’s schemes allow members to claim back on GP visit expenses. Depending on the scheme and level of cover, these may be claimed back either as a fixed amount or as a percentage of the value of the GP consultation, up to 75 per cent. Remember, you can claim 20 per cent tax relief on medical expenses, including GP fees and prescription charges.

All Laya Healthcare schemes provide unlimited 24/7 telephone access to family doctors through its GPLine and also to three free video consultations through GPLive, which operates seven days a week. On some schemes, patients can have more than three video consultations a year without any extra cost.

VHI also includes free access to an online GP service in most of its policies, covering between eight and 12 uses, depending on the plan chosen.

The Irish Medical Organisation (IMO) has called for regulation of telemedicine, warning that online GP consultations should not and cannot replace a face-to-face consultation with a GP.

4) Think nurse

The majority of the country’s 3,500 GPs now work alongside at least one nurse, who can provide services such as vaccinations, blood tests, ear syringing and contraceptive pill check. Seeing a nurse rather than a doctor can save a private patient anything between €15 to €30 a visit. If you’re unsure whether or not a nurse can meet your needs, enquire when booking the appointment.

5) Prepare to use your appointment time wisely

A GP will expect to spend an average of 10-15 minutes with you, hoping the quicker, more straightforward visits will balance out the longer, more complicated cases over the course of a day and prevent congestion in the waiting room.

It is okay to raise two or more seemingly unconnected ailments, says Cox, because they may be connected. However, prioritise what is worrying you most so that can be given full attention. Some patients don’t get around to mentioning the worst symptom until they are halfway out the door – at which stage you might need to make another appointment.

While the best GPs won’t appear under pressure, the clock is ticking so it is worth taking the time before your visit to think about how you can communicate your concerns and your symptoms in the clearest way possible.

It is essential to bring a note of any medications you’re on, although the surgery should have an accurate record of what you have been prescribed there. However, mentioning that you are also taking a “white tablet” since a visit to an out patients’ department is not much use if the GP has not been updated about that. The bottom line is, know your medications – or bring them with you.

Take notes during the consultation if you think it would be helpful for recalling advice or next steps.

6) Regard Dr Google with caution

The patient who is worried “will always find the scary stuff” online, says Cox, “and the scary stuff is taken out of context”. On the positive side, the wealth of information available can be helpful in giving you a better understanding of, say, a treatment option your doctor is suggesting. And if you have done extensive research into a long-standing condition, you may well be able to broaden the conversation.

But keep an open mind going in. Don’t let any inclination to believe that something you have read on two or more websites must be true over-ride the professional judgment of the doctor sitting opposite you in real life.

7) Consider if you want someone with you

An advocate may be absolutely necessary for somebody with, say, a learning disability or early dementia. If it is just a personal preference to bring somebody with you as a support or another pair of ears and clearer mind, that’s your right.

But be mindful that three in the room can change the dynamic. Be firm with a loved one, no matter how deep their concern and keenness to accompany you, if you would prefer to go alone. It may allow for a more open conversation between you and your doctor.

If English is not your first language, appointments can be a struggle and the availability of translation services is very limited. But is it really appropriate to bring your child to translate for you, no matter how good their English, if you are going to need to describe something quite private?

8) Bypass the hospital emergency department waiting room

Even if your illness or injury warrants more treatment than a GP can offer, a consultation can, at best, fast-track you to an appropriate medical or surgical assessment unit – if there is one available in your area. Or, at least, it will save you about €40-€50 if you need to join the hospital ED queue because the €100 Government levy on private patients is waived if you come in with a GP referral letter.

“GPs in many areas have alternative routes into hospital and maybe more appropriate routes into a medical assessment unit or surgical assessment unit, and can help patients avoid the blockage that is A&E,” says Cox.

You can also self-refer to any of the HSE’s 11 injury units but the same €100 charge is payable there. Also note that none of these units treats children under five, nor do they handle serious head injuries, abdominal pain, medical illnesses or mental-health problems.

Parents living in the north and west Dublin area and hinterland should be aware that the Children's Urgent Care Centre at Connolly in Blanchardstown is now open for "walk in" minor injuries and illnesses, such as broken bones, dislocations, sprains, wounds, stitches, scalds, croup and respiratory syncytial virus (RSV), among those aged 0-15 years (but not for fever in babies under 12 weeks). Again, the €100 fee applies.

Waiting times will be shorter than in ED but if, after assessment, your child’s condition is judged to be more serious than you thought, they will be transferred to one of the city’s three paediatric hospitals.

The main health insurers offer members subsidised access to private minor injury clinics in some areas. These are also open to non-members but can be costly. For example, an initial doctor consultation at an Irish Health approved clinic will cost a non-member €150, at a VHI Swiftcare clinic, it is €125 and at a Laya clinic, non-members pay €130. Additional treatments at all three cost extra, such as an X-ray (€90-€100), stitching (€50-€60) and full cast (€60), only some of which may be covered by your health plan.

9) Respect the age of medical consent

Parents should be aware that the age of medical consent is 16, so your teenager can then ask to see the doctor alone and confidentiality is absolute. You may think information on whether or not your daughter has been into the surgery asking for the contraceptive pill is a parent’s “need to know” but your GP will have to politely tell you that you won’t learn it from them.

10) If in doubt, phone for test results

GPs should follow up the results of any tests which they have commissioned for patients. But you probably won’t be contacted if the result is normal and no further action is needed. While most practices will be scrupulous about checking results, as a failsafe they may well encourage you to ring in and check, a “double insurance”, as Cox puts it. “It is one of those areas that can go badly wrong” – if a GP misses a test that needs attention.

However, what is contentious among GPs is if you decide to attend a private clinic for a health screening and it then sends a detailed report back to your GP on the results, saying you need a follow-up on this and that. “We didn’t have anything to do with ordering them; we didn’t have anything to do with the context, why the patient went, the concerns and worries, and we are being asked to follow up these,” says Cox. Perhaps, if you do want to avail of a “health consumer” screening but value the relationship with your own doctor, ask the clinic if it has raised any concerns you should bring back to your GP in person.

11) Know you are entitled to a copy of your GP records

You can ask for a copy of all notes on you that a GP holds. Public patients are meant to process such requests through the Freedom of Information and the HSE. Anybody can also apply through the Data Protection Act for their own personal information, but not for that of another family member, including a child who is capable of understanding the right to privacy, without signed consent.

If you want your records to transfer to another GP practice, or to use in seeking a second opinion from another GP, it is best to be upfront, as doctors would prefer to send them through healthmail, a secure, clinical email service provided by the HSE.

12) If you’re not satisfied with the service you receive, follow complaints procedures

If you’re unhappy, make your point directly to the GP in the first instance, either in person, by phone or by writing a letter. If their response doesn’t resolve the situation for you, the next steps depend on whether you are a public or private patient.

If you have a medical card or GP visit card, contact the HSE and use its Your Service Your Say complaints procedure. It promises to respond to written complaints within 30 days. (You can also, of course, use this email/phone/online service to pass on compliments about GPs.)

If you're not happy with that response, you can either request an internal HSE review or an external review, through the Office of the Ombudsman or the Ombudsman for Children's Office.

If, on the other hand, you are a private patient and believe there has been professional misconduct or poor professional performance by your GP, you should go to the Irish Medical Council.

The council is the regulator for all doctors working in Ireland and after you lodge a written complaint, a case officer will be assigned to help its Preliminary Proceedings Committee (PPC) investigate the complaint.