Professor John Wass
Radcliffe Infirmary, Oxford

Katherine White
The Addison's Disease Society

Good communication between a patient and their consultant is essential for an effective relationship. There are things that both sides can do to help make this happen. Patients should not be afraid to do their own reading. The Internet is a good source of medical information, always remembering that not all the information on private sites is accurate, so patients need to be discriminating.

Patients are at liberty to ask about their doctor's knowledge in the pituitary field: ask how often they have seen the condition and what their success rate is. Patients should feel free to suggest a possible diagnosis for their symptoms, to ask for detailed information about their condition and to remain in the clinic until they have the information they need. Some questions patients may ask are:

• Are all the relevant test results available?
• Can these tests be done in advance of clinic visits so the results are ready on the day of the appointment?
• What obligation do GPs have to find out about a patient's condition?
• How do consultants report a patient's test results back to their GP?

From the doctor's point of view, there typically appear to be "good" and "bad" patients. The good patient arrives for appointments on time and provides clear, accurate information about their health. The bad patient appears moody and unpredictable, often doesn't turn up for appointments and seems to give misleading information, to the extent that their doctor instinctively doesn't trust them. Paradoxically, a very sick patient can give the impression of being a bad patient. Extreme illness and fear of not knowing what's wrong can make people scared and angry. Exhaustion can cause patients to cry easily, forget their appointments and skip over symptoms, while continuous pain causes tiredness, irritability and depression.

The most helpful thing the patient can do is to be organised. This means writing down symptoms and questions prior to an appointment, and perhaps taking a note pad or tape recorder to the consultation to keep a record of the advice. (It's always advisable to request the doctor's consent to record their conversation.) Taking a friend with you may help; someone who can prompt you to raise important symptoms you have forgotten to mention, or who can simply listen to the doctor's advice and remind you of it afterwards.

Professor Wass discussed the qualities that make an Endocrinologist a good communicator. Consultants must educate both patient and carer about the condition, including information they need to deal with emergencies. They should assess the patient's state of mind as well as physical condition and be accessible between clinic appointments by phone or e-mail. Patients should tell their endocrinologist what they want to know about their medical condition and what they hope to gain from the appointments.

Professor Wass often sends his patients a copy of the follow-up letter sent to their GP, in which he summarises the discussions at the clinic, any test results and changes of medication.

He reminded his listeners that there are occasions when even the best doctor is unable to give the patient their full attention, e.g. if they have recently experienced a bereavement. If a patient feels dissatisfied with a clinic appointment they can write to the doctor expressing their concerns and requesting further tests to reach a diagnosis.

Katherine White recommended that patients should read as much up-to-date information as possible as there are constant advances within the field of endocrinology and out-of-date textbooks can give a misleadingly gloomy picture. She suggested that patients should always ask their consultants' views of the material they have been reading.

In conclusion, Professor Wass quoted "Patients who irritate their doctors the most live the longest". However, try to come to a compromise in your relationship with any doctor, as ideally it should be a mutually rewarding relationship.