A matter of some urgency?

A while back I phoned up my GP surgery to make an appointment and was asked whether it was urgent. I replied in the negative and was given a slot 3 weeks later, which was fine. But it got me thinking about the subjectivity involved in answering that question.

‘Urgent’ means different things to different people in different settings. The email that you flag as ‘high priority’ may languish near the bottom of my to do list. A hurried driver’s excuse for jumping a red light may not wash with the authorities. A web search on ‘This is urgent’ shows that some people are rather casual in their use of the word.

My on-the-spot response to whether my medical concerns are ‘urgent’ involves appraising whether I’m in a fair bit of pain, whether bits of me are no longer attached as they’re supposed to be, or whether anything that should be on the inside is now on the outside. Arguably, some of those things might be better classified as ’emergencies’ so perhaps I am setting the threshold too high. But what about that nasty cough I might suspect to be a chest infection? I wouldn’t call that ‘urgent’ but I would nonetheless want to start antibiotics within a day or two. So even my own definition of ‘urgent’ in this context lacks consistency.

I started wondering whether there were any potential adverse consequences of asking patients this question. If everyone who needs medical attention receives it in a timely fashion then it doesn’t matter at all. But we know that people access healthcare in different ways, and that some things should be dealt with sooner rather than later. How might a person with undiagnosed depression, who has struggled to summon the energy to make an appointment, self-assess the urgency of their condition? Would they keep an appointment at a later date or would it be too much of a struggle? What about the casual worker who is unable to turn down work and can’t predict what their availability might be next week? How might someone interpret that small but niggling symptom that might be indicative of cancer? In what ways would Mr Worried Well’s self-assessment differ from that of Mr Mustn’t Grumble?

By asking patients if their appointment request is urgent we’re conducting an informal triage, based on insights from people who might not be best placed to assess the situation. Though the reasons for asking are good, perhaps we should consider what effects such a query might have on access to care.

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4 comments

  1. doug salmon · · Reply

    Your post nicely illustrates why academics need to be kept well away from the “coalface” of medicine. Out in the world beyond your ivory tower, we have to deal with demand that exceeds supply, and make decisions. Pragmatic solutions that work the are key to survival.

    1. I don’t doubt in the slightest the absolute pragmatic necessity of such a question. But it is always worth asking whether there are unintended consequences of what are otherwise sound protocols.

      For what it’s worth, I was prompted to write that post as a healthcare user, rather than as an academic. Patient access to services does not always reflect need, and I wondered whether this was an access point that contributed at all (I suspect in the grand scheme of things it’s probably not a major one, but I wanted to think it through).

      Keeping academics ‘away from the coalface’ seems an odd way of fixing any misconceptions. I find working alongside clinical colleagues is improving my understanding of how knowledge translates into practice. I hope the learning process works both ways.

    2. This is a very outdated (and arguably egocentric) view of clinical practice. Minimising the gap between the ivory tower and the bedside has a range benefits, not least for the patient (e.g. see Sumit et al 2008 Arch Intern Med 168(6):657-662 for benefits to the patient). This is practically the founding principal of the NIHR. I don’t doubt the tremendous challenge of making life-changing decisions under the pressures of both time and supply, but I would suggest this is where high-quality translational research becomes all the more valuable.

  2. Chris burton · · Reply

    We have a practice policy that staff do not ask if something is urgent. They offer either book ahead with choice of GP etc or first available which is either 48h or GP call back triage. For the reasons you state.

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