how to treat your doctor ...

Are you a `heart-sink' patient, a patient with attitude, or a middle-class know-it-all? Then you're not likely to get the best out of your overworked doctor. Bedside manners are a two-way thing,

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octors have never commane universal respect. It was Voltaire who claime that ``a physician is one who pours rugs of which he knows little, into a boy, of which he knows less''. But unfortunately, we cannot o without them.

So how can we get the best out of them? How can we ensure that they take what we say seriously, tell us everything we nee to know an o not talk own to us?

The Government has just launche a pouns 2.75m campaign to iscourage us from bothering our octors with trivia, the unerlying message of which is: ``be nice to your poor oc. He's increibly overworke, what with community care, the Patient's Charter, early hospital ischarge, all of which we have lumbere him with, but which, sure as hell, we are not going to o anything about''. While the Government might exhort us to be nice to our GPs, how can we ensure that they are nice to us? Dr Laurence Buckman, a north Lonon GP, has a simple message: ``treat us as professionals, just like you woul treat your solicitor, accountant or bank manager''.

He says that he oes not want his patients to be obsequious an subservient, but nor oes he want them to be over-assertive or aggressive. ``Doctors an patients shoul work together as partners. Don't come in an tell your octor what to o. He is not your servant. You shoul negotiate about what nees to be ealt with, what is important, about whether you nee reassurance or an investigation.'' He oes his best to train his patients not to come in with minor complaints. ``I say: `o not come in with a sore throat unless you can see yellow pus on it. No pus, no treat'. Most of these things, like flu or coughs an cols, will get better by themselves. When I tell a patient they have a virus, it is meical jargon for: `go away, because there is nothing I can o for you'.''

He gets fe up with people coming in an emaning that he write a letter for them, as though he is their secretary. They request letters for housing officers, employers or private octors, with whom they have alreay mae appointments. ``I always say: `if you want a letter, you can rent my typewriter'.'' A little politeness goes a long way. Dr Gill Yukin, a GP in Kentish Town, Lonon, sai: ``if a patient wants a visit an starts off with the wors `I am sorry to isturb you, but ...' a GP will o almost anything. If they start with the wors `get the f--- over here' a GP will be resistant to going an the chances of a goo consultation are remote.''

Patients ``with attitue'' are obviously a problem for GPs, who feel that they have become a umping groun for all society's problems. If social services cannot sort someone out, they sen them to their GP, as o staff in accient an emergency epartments, pharmacists, friens, relatives, an everyone else. GPs are easy targets.

But supposing you are not a patient ``with attitue'', but a thoroughly well-behave, fully pai-up member of the courteous tenency, what tips can octors give? Dr Peter Holen, a GP from Matlock, Derbyshire, has a few suggestions. ``If you know that you are going to take longer than the usual appointment length, which is usually eight minutes, tell the receptionist an ask for a longer appointment; an if you think you nee a home visit, ring up before 10am, so that a the octor can plan his ay.

``I work in a semi-rural area an I get fe up with people asking for a home visit late in the ay. Toay I have been back to the same village three times, for three separate visits. If the patients ha all phone early, I coul have groupe them together. One visit took an hour, only three minutes of which was meicine, the rest was travelling.''

Like many other octors, Dr Holen feels that patients o not appreciate what stress the health service is uner. ``Patients shoul realise that the NHS is uner-resource. It is a service uner siege. It functions only because of the eication of the staff. Many of us o not eliver the goos the way we woul like, but it might be because we are coming to the en of a 30-hour shift or a 25-patient surgery.''

Few people know that each GP in Britain is responsible for about 1,800 patients. Certain phrases are guarantee to put a octor's back up. Dr Buckman cannot stan: ``I'm sorry to call you out at night octor, but I was so busy at work all ay, that I i not have time to see you.''

His reply to that is: ``Well, I've been busy too. I have one an 11-hour ay. What have you one?''

Other phrases, which are probably worth avoiing, inclue: ``this article in the Inepenent on Sunay says that I can have my wrinkles remove on the NHS/my heart transplant one on an out-patient basis/a longer than usual appointment with my GP'', or anything else of the same sort. Such habits can easily get you labelle as a pushy, mile-class, know-it-all. Only slightly worse than being labelle ``a know-it-all'', is being known as a ``heart-sink'' patient, which is someone who makes the octor's heart sink, when they enter the surgery. This can happen if you visit your octor too often, are constantly miserable an complain of being `tire all the time' (commonly abbreviate to Tatt).

Many organisations, such as the Patients' Association an the Consumers' Association, recommen that patients take a list of questions or symptoms with them, so that they o not forget what they want to ask their octors. Doctors o not usually object to this, as long as the list is not too long.

``I like lists, but patients sometimes come in with ones, which have 20 questions on them, which is unrealistic,'' says Dr Buckman. ``But I usually ask them to give me the list all in one go, so we can work out our priorities. Invariably, it is the last point that matters, just as it is often the remark they make when leaving the room which is the most significant. It will be: `oh, by the way octor, I am impotent'. Or `my wife makes herself vomit after every meal. Is that normal?' Or `I get crushing pain in my chest, every time I go upstairs'.''

The Patients' Association has a hany booklet, entitle How to Get the Best Out of Your Visit to the Doctor. It is useful because it tells it like it is, rather than how it shoul be. For example, it says: ``o not be put off by the octor's boy language. Some are notorious for their ba communication in this area''. An ``when you are asking your GP questions, o not ask them aggressively. Be as unthreatening as possible - for some reason octors feel threatene very easily''.

It is unoubtely true that octors o often feel threatene. Dr Buckman, for example, a man of apparently robust temperament, oes not like it if his patients ask: ``are you sure?'' after he has given them some avice. Yet we might well ask that question of our accountant or solicitor, without expecting them to take offence. It is often just an expression of increulity or unhappiness at what the octor has avise.

But there is the rub. We often o not like what the octor has to tell us. Visiting our octor is not like visiting our bank manager, because there is more riing on it. Discussing your health is more emotive than iscussing your conveyancing. There will always be tension between patients an octors while octors have to break ba news or tell us that they cannot o anything for our particular preicament.

``We have many families, who have no religious faith, their relatives are miles away an they meicalise their problems. They want us to provie them with an answer. They want instant gratification an we cannot provie it,'' sai Dr Holen.

His wors were echoe by Dr Buckman. ``We are not in the happiness business. We are not there to give patients what they want, but what they nee.''

Personally, I prefer octors who give you what you want. A frien of mine in the Unite States has an excellent octor. When she tol him that she coul not affor the operation that he recommene, he offere to touch up the X-ray instea. Now that's what I call helpful.