Psychological issues have topped the list of patient presentations in general practice for six years running, according to the Health of the Nation Report—so GPs are getting plenty of opportunities to hone their skills.
But many still lack confidence in their ability to make a difference with these patients, says GP and psychotherapist Dr Susan Barnett.
GPs sometimes think, ‘I’m just a GP; I can’t do psychology,’ Dr Barnett says—but she begs to differ. “Many GPs are doing amazing psychology in their consult rooms on a daily basis, yet the commonly known imposter syndrome often creeps in,” she says.
“Providing a safe space for a patient to simply cry and describe their distress to you is therapy. When a patient feels seen, heard and valued—true connection is created. Many GPs do not realise this—they think there is something magical that psychologists are doing.”
Research by the American Psychological Association has suggested that aspects of the therapeutic relationship can not only predict a patient’s improvement, but probably cause it.
“There is evidence that creating a safe and trusting therapeutic relationship has a significant impact on patient outcomes. So if you can create a positive therapeutic relationship, you are going to be contributing to healing,” Dr Barnett says.
So how do you get the therapeutic relationship right?
Being a mindful GP, using active listening skills, validation, empathy and curiosity, and demonstrating non-judgmental, non-verbal body language are all key factors.
“These are skills that all GPs can be taught,” Dr Barnett says. “Many intuitively are already doing it and do not realise this.”
She says there are also many simple resources that can be easily integrated into a GP consult, even when time is tight.
For example the ‘Healthy Mind Platter’ which highlights seven key activities to improve wellbeing, the ‘hand as brain model’, smart goal setting and focussed problem solving resources are all easy to teach.
“Unfortunately, our Medicare system is such that it doesn’t encourage long consultations,” she says. But there are strategies GPs can practice, such as the ‘golden minute,” that help make standard consultations move more efficiently.
The golden minute involves asking the patient, ‘how can I help you today,’ as soon as they come in, and then being completely present and truly listening without any interruption for at least one minute.
“This will lead to the patient feeling truly seen, heard and valued,” Dr Barnett says. “This simple approach leads to early identification of the patient’s agenda. Too often when we are rushing, we interrupt and move into closed questions to help us determine the diagnosis, yet we miss the patient’s reason for attending on this particular day.”
That can be counterproductive, inadvertently leading to a longer consultation, or the patient may leave feeling dissatisfied.
Dr Barnett says that if a patient is distressed, simply giving them time and space in silence can be helpful. When they start to settle, you can respond using the empathy formula: ‘I can see that you are… (insert feeling) because…(insert reason for their distress).’
This helps a patient feel seen and heard, which often helps reduce distress, Dr Barnett says.
Dr Susan Barnett will be sharing more practical strategies that GPs can use to do psychological medicine better at the upcoming Australian Society for Psychological Medicine conference at Hamiliton Island in May. Register here to attend.
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