Length of GP consultations 'should be controlled by patients'

By Stephen Robinson, 20 February 2013

Practices should let patients choose how long they spend with their GP when they book an appointment so they feel more 'empowered', academic GPs have suggested.

Letting patients control consultation length can boost relationship with GPs

Letting patients control consultation length can boost relationship with GPs

A scheme that allowed patients to book appointments lasting between five and 20 minutes was 'largely welcomed' by doctors at the pilot practice, according to researchers writing in the BJGP.

The study's lead author told GP the system helped to break down barriers between patients and doctors, and could be adopted more widely. But a senior GP said the idea may be unworkable in busy practices.

Cairn Medical Practice in Inverness allowed patients to book routine appointments lasting five, 10, 15 or 20 minutes in December 2011 and January 2012.

Doctors recorded their experiences using an audio diary and took part in focus group discussions. Patients were interviewed after their consultation.

Researchers analysed responses from 56 patients. Patients said the new system allowed them to plan more effectively what they wanted from an appointment, and gave them more confidence and less anxiety in the consultation room.

'I was dreading coming in'
However, there was a mixed response from doctors. Some GPs worried that patients had chosen an inappropriate length of appointment, saying this could affect how well they could manage the patient.

One doctor said he or she initially 'dreaded' heading into work in the morning, fearing many 5-minute slots.

Yet other GPs felt more at ease, saying the patient seemed more empowered and they felt 'less rushed and more relaxed'.

Researchers said the system gave doctors a better sense of agreement with the patient over their care, greater satisfaction for the doctor, and more time to tackle issues such as health promotion.

Study authors wrote: 'Both doctors and patients described a greater perceived sense of patient empowerment in handing over the freedom to choose appointment length. This shift in power was largely welcomed, with doctors describing a more balanced relationship and patients feeling more confident and better able to manage their consultation.

They added: 'The sharing of power, however, was not universally welcome; for some patients there was anxiety over whether this would have a negative impact on the doctor’s time and a concern about how some of their fellow patients might misuse the freedom to choose appointment length.'

Study lead and GP Dr Rod Sampson, who works at the pilot practice, told GP the system 'could be adopted more widely'.

However, he said it may not meet all the needs of doctors or patients, and all parties would need education to get the most from the system.

Dr Sampson added: 'For me, the greater sense of patient empowerment - as perceived by both GPs and patients - the greater sense of patient responsibility for time management within the consultation, and the sense of a more equal relationship were of interest.

'By specifically ensuring that the sharing of ideas occurs, doctors break down the stereotypical model of doctors as experts and patients as individuals with little knowledge or feelings about their problems. This respect for a patient’s view is extended in our study by specifically respecting their capacity to choose the length of time they require with the doctor.'

Berkshire GP Dr George Kassianos said questions remain over the long-term sustainability of the idea. He said patients with very short appointments could miss out on opportunistic health checks.

He added: 'I cannot see how a surgery with a defined number of doctors can plan its work with patients choosing how long they think they want to be with the doctor.'

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