Dr Phil Hammond, GP, lecturer and presenter of BBC2's Trust Me, I'm a Doctor

Why do some doctors buzz patients while others fetch them in person (FIP)? Ever since the invention of electricity, buzzing has been the norm for doctors who considered it far too secretarial to fetch their patients to and from the waiting room.

Early intercoms were not best known for their voice quality, and patients were left to guess if they were being summoned, based on a knowledge of their appointment time and the number of syllables they thought they heard Dr Ick say, e.g. 'Mr/s Hmhp-hum, to Dr Ick please'.

If the surgery boasted a Dr Dick as well, then the intercom was doubly confusing.

So why hasn't it been replaced?

Because doctors never ask patients for feedback, and patients were, until recently, much too respectful to volunteer it. So most of us are blissfully ignorant of our communication failings.

To be fair, modern intercoms tend to go through the practice telephone network and are of much better sound quality, the only drawback being that if you consult with the receiver slightly off the hook then the whole waiting room gets to hear about Mrs Miggin's warty growth.

Lovely. And what about FIPing?

FIPing has always been popular with doctors who are into the personal touch. The early eye contact and reassuring smile can do much to assuage the anxiety of embarrassing itch.

FIPing also allows the doctor to loiter outside the waiting room door and stare through the crack to survey his next patient. Mr Bishop is doing 'unobserved' handstands in the toy corner but assumes a look of chronic worldweariness the moment a doctor appears. Why?

Why?

I don't know. I'd need to gather more information.

But the beauty of FIPing is that you start observing patients immediately, from the moment they try to get out of those ludicrously low bucket seats to the moment they set foot in your consulting room. Do they look sick? Can they walk properly? How will they fit that double buggy through the door without chipping the paintwork? Should the doctor walk in front or behind?

A colleague of mine is convinced that he can dictate the pace and style of his consultations by the manner in which he leads the patients to his room: a leisurely stroll if he's not too pushed for time, a brisk trot if he is. I've seen a video of this and the brisk trot looks a lot like he's concealing a tuberous vegetable about him, but there might be something in it.

So FIPing gets your vote?

On the whole, yes. It's particularly useful if someone's left an unfriendly aroma in your room and you need a few moments to clear your head.

But also, patients seem to like it. If they're seeing a familiar doctor, they can pack in an extra minute by addressing the bunions on the stairs. And if it's a new doctor, they can decide whether they want to bring up psychological issues (e.g. the impending trauma of Christmas with the in-laws) or stick to the tennis elbow.

And it cuts down on mistaken identity?

Yes and no. If the doctor is minimally articulate, then FIPing is more reliable than an intercom. But for new and amnesiac doctors, it's a source of constant embarrassment.

Say your next patient is Mrs Thomas, aged 50. When you get to the waiting room, there are four women fitting that description. Who do you bestow the all-important early eye contact on?

And what if you saw her only last week and haven't the faintest recollection what she looks like? Your only option then is to stare at the linoleum, which makes Mrs Thomas think you're not in the least bit interested in her. Also, if none of the women are Mrs Thomas, you can spend a long time staring at the lino. Ten minutes is my record.

Any other drawbacks?

Successful FIPing depends as much on the geography of the surgery as the style of the doctor. If the waiting room's on the ground floor and Dr Dick is on level six, you can't expect the poor man to rush up and down the stairs every six and a half minutes.

When I worked in such a surgery, I could never get down the stairs anyway because they were blocked with patients who'd either collapsed on the way up or were just taking a breather.

Guidelines in Practice, August/September 2000, Volume 3
© 2000 MGP Ltd
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