‘My patients are “gunning for a fight” that I don’t want’: reflecting on feeling dismissed and conflict- expectant consultations | British Journal of General Practice

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Gunning for a fight?
Paul van den Bosch

Published on: 05 May 2025

Published on: (5 May 2025)
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Gunning for a fight?
Paul van den Bosch, GP, College Road Surgery, Woking
There are some practical steps we can take to help us manage the important issues raised here.

Firstly we as doctors need to look at our own roles in 'priming the gun'. Which of us has not advised family or friends as to what they might expect from a GP consultation and how many of our interactions follow advice given by fellow medical professionals? A&E is a particular source but there are others and we know that suggestions to patients that they might ask the GP 'to think about investigating your abdominal pain' are often reframed as 'the other doctor said I must have a referral and an MRI.' There are some educational opportunities here to help medical professionals prepare patients to see their GP consultation as a source of advice rather than an obstructive gateway to further care.

The second area of influence lies within the consultation itself. The expectations question in the online triage can be helpful in preparing us but the critical step is to overcome our instinct to bridle when presented with a demand we consider unreasonable. It can take an effort but we need to ensure that we open positively with acknowledgment, affirmation, support and often a simple 'yes of course'. The stress on both parties is immediately reduced and minds might even be changed.

Competing Interests: None declared.

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