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How a ‘grumpy’ GP can have a disproportionate effect on a young person’s health

Caffeine and contemplation

Dominique Thompson

Monday, 13 May 2019

AdobeStock_91502197_grumpy.jpgWe have all been there. Seeing the patient who has taken an urgent appointment for a non-urgent problem. The irritation can sometimes be hard to hide if you’re the healthcare professional ploughing through a high pressure day and feeling a little worn out.

Wait though, and take a moment. Especially if the patient in front of you is under 25.

You may feel that young people should be treated no differently from anyone else, or that the systems are there for all patients to be managed equitably, but perhaps we do need to think about young people differently.

Young people under 25 are different. Their brains are different. Their thinking patterns are different. Their life experience is different.

So perhaps for the following reasons we should cut young people under 25 a little slack.

  • We may expect all patients to use the same system to access healthcare, but some of our patients come into it with little understanding of that system, and vastly differing reactions to poor health. They are not necessarily used to being ill, and accessing an unfamiliar environment for help can be frightening or overwhelming. We should not assume that they will be able to put their symptoms into our context (urgent/ non urgent) and then make the ‘appropriate’ decision about the care they need.
  • Young people’s brains are developing until about the age of 25 and the last zone to develop oversees impulse control (the pre frontal cortex). It is possible therefore that, when faced with a stressful situation, their decision making process may not be as developed, balanced and thought out as that of someone in later life (who also has more life experience to draw on). This may mean that they deal less calmly with the uncertainties of pain and ill health and are more impulsive in tackling them – for example they may anxiously book an urgent appointment when the problem may not warrant it. In other words when they believe that they need an appointment they book it- not that they won’t wait, but that they can’t (neurobiologically) always wait in an unfamiliar scenario. This may be frustrating for us, but it is not necessarily their ‘fault’.
  • It can take a lot of courage and be very stressful for a young person to book a healthcare appointment. They fear not being taken seriously, or being dismissed as ‘silly’ and they fear the unknown of what may happen next. They fear ‘getting it wrong’. If the reaction they receive from any of us in the healthcare team (including receptionists) is unwelcoming, lacking in compassion or understanding, then whilst they may only have come for a minor issue this time, you can be sure they are much less likely to come back for a more serious problem next time, as they will be terrified of getting it wrong, and won’t know how to be sure that their symptom is ‘significant’ enough.
  • The other big difference between the younger and older generations attending an appointment and receiving a somewhat frosty welcome is that an older person will have the life experience to understand that the professional may be having a bad day, may not always be like this, may be dealing with a family issue, or workplace stress. An older patient may be able to empathise that we are not always our ‘best self’ at work (despite our best intentions and usually great consultation skills) whereas a young person will have little of this context and life experience and will take the consultation at face value. This might then be their frame of reference for all future encounters, and will colour their view of healthcare, because young people (whose brains as we mentioned are still developing) also have an increased tendency towards black and white thinking. They allow for much less greyness in life. They may in future see all healthcare professionals as grumpy and this can have a disproportionately negative effect on their health-seeking behaviour in future.

These young adult responses and conclusions can ultimately create barriers to seeking help, which can in some cases prove disastrous or even have tragic outcomes.

So next time a young person irritates you by booking the ‘wrong’ appointment or by coming in with something ‘minor’, try to remember that you can also have a disproportionately positive effect on their future health care by being compassionate, caring, and educational in your approach, knowing that when it really matters they may then be more likely to seek help than ignore something important (such as their mental health). 

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Dominique Thompson

Dominique has been a student health GP since 2000, developing innovative new services to treat eating disorders and personality disorder in primary care. She was the GP member of the NICE Eating Disorders Committee 2017. She was a Pulse ‘GP hero’, in 2014, and a ‘Rising Star’ in 2016. Dominique writes about young adult wellbeing and mental health, in both the medical and non-medical press. Her latest adventure is as an independent consultant in student health and wellbeing www.buzzconsulting.co.uk. She is fuelled by caffeinated drinks.
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