A common question posed by doctors, “What is it you’d like me to do?” often elicits frustration from patients seeking a diagnosis. While many perceive it as dismissive or a sign of the doctor shirking responsibility, medical professionals explain it’s a crucial part of a patient-centered approach aimed at understanding individual needs and expectations.
The Patient’s Perspective: Frustration and Confusion
For individuals experiencing unexplained symptoms or chronic conditions, the expectation is that a doctor, with their extensive training, will provide answers and a clear course of action. When instead they are met with the question, “What is it you’d like me to do?”, it can feel like a deflection. Social media platforms have become a space for many to voice this discontent. Patients have shared their exasperation, with comments ranging from “I don’t know, I’m not a doctor” to “I wasn’t the one who went to med school for five years!”
Some patients find the question condescending, likening it to a gaslighting tactic. The sentiment is that they are coming to a medical expert precisely because they don’t know what to do and are looking for guidance. This perceived lack of directness can be particularly demoralizing for those dealing with complex or long-term health issues where diagnosis and treatment are already challenging.
The Medical Rationale: Understanding Expectations (ICE Framework)
However, medical practitioners explain that this question is not arbitrary but rather a deliberate component of effective communication during consultations. Dr. Ben Davis, a GP and therapist, highlights that this question is a standard part of medical training and falls under the “Ideas, Concerns, and Expectations” (ICE) framework. The ICE framework is designed to ensure that consultations are patient-centered, allowing doctors to grasp the patient’s viewpoint and agenda fully.
The question “What is it you’d like me to do?” specifically addresses the “Expectations” part of ICE. Dr. Davis explains that without asking this, a doctor might make assumptions about the patient’s desired medical intervention, investigation, or treatment. These assumptions could be incorrect; a patient might primarily be seeking reassurance rather than immediate medical action or further tests. By understanding the patient’s expectations, doctors can tailor their approach more effectively and avoid interventions the patient may not want or need.
Why Understanding Expectations Matters
- Patient Autonomy: It respects the patient’s right to have a say in their healthcare decisions.
- Tailored Care: It helps doctors provide care that aligns with the patient’s goals and comfort level.
- Avoiding Unnecessary Interventions: It prevents doctors from pursuing treatments or tests that the patient might not desire or find beneficial.
- Building Rapport: It fosters a collaborative relationship between doctor and patient.
When the System Falls Short: Jess’s Rule and Diagnostic Delays
While the ICE framework aims to improve communication, it’s acknowledged that it’s not foolproof. There are instances where patients express concerns and request interventions, yet their needs are not adequately addressed. This reality underscores the importance of systemic changes to ensure patient safety and timely diagnosis.
One such initiative is “Jess’s Rule,” implemented in 2025. This guideline encourages GP teams to re-evaluate a patient’s condition if they present with the same symptoms or concerns on three separate occasions. This rule was established following the tragic death of Jessica Brady in December 2020, at the age of 27. Jessica passed away from cancer, having had 20 consultations with her GP practice over five months prior to her diagnosis, during which her illness was not identified.
The challenges in diagnosing certain conditions are starkly illustrated by the average diagnostic time for endometriosis, which currently stands at nine years and four months. Alarmingly, 39% of women with endometriosis visit their GP 10 or more times before the condition is even suspected. These statistics highlight systemic issues that can lead to prolonged suffering and delayed treatment, making the communication during appointments even more critical.
Reframing the Doctor-Patient Dialogue
Dr. Davis acknowledges that the question about expectations can indeed be misinterpreted, especially when patients feel they are coming to the doctor specifically for answers. “It can be misinterpreted, but it’s good for a GP or doctor to know whether you’ve had thoughts about what could be helpful so you can create a plan together,” he states.
He suggests that doctors can reframe the question to mitigate potential misunderstandings. Instead of a blunt “What do you want me to do?”, a doctor might say, “I have my own ideas about what might be helpful, but could you tell me what you would like to happen?” This phrasing invites collaboration and acknowledges the doctor’s expertise while still valuing the patient’s input and desires. Understanding the patient’s perspective on their own health journey is paramount, and this seemingly simple question, when used effectively, is a key tool in achieving that understanding and fostering a partnership in care.
Conclusion: A Collaborative Approach to Healthcare
The question “What is it you’d like me to do?” serves a vital purpose in medical consultations, aiming to align the doctor’s approach with the patient’s individual needs and expectations. While it can understandably cause frustration, particularly for those facing diagnostic challenges, understanding its role within frameworks like ICE reveals its intention to foster a more patient-centered and collaborative healthcare experience. Initiatives like Jess’s Rule further emphasize the ongoing efforts to improve diagnostic pathways and patient outcomes, ensuring that every patient’s concerns are heard and addressed effectively.
