Consultation Skills - Control the length of the consultation

Many factors affect consulting time, but they are not all out of your control, writes Dr Mona Kular.

Consider inviting the patient to reattend for another appointment if they present with ta list of problems
Consider inviting the patient to reattend for another appointment if they present with ta list of problems

Consultation times in general practice have increased over the years; the average length of a consultation in 1990 was 8.33 minutes and 9.36 minutes in 1997.1 By 2003, the median consultation length was 13.3 minutes.2

Most surgeries book patient consultations at 10-minute intervals. Difficulties with time management and running late are common among GPs and can be stressful and frustrating for both patients and GPs.

With more complex health problems and the need to gather ever more information during consultations, it seems as though consultations are set to get longer.

There are a number of factors determining consultation length and various methods can be used to keep on track. Indeed, there is also some evidence to suggest that consultations do not have to be long in order for patients to feel satisfied.3

Factors affecting length
A number of specific factors have been found to increase the length of the consultation, including the presence of psychosocial problems and a positive attitude toward them by the GP.

New problems, city-based practices and female patients are also associated with longer consultation times.4 It would also seem logical that those presenting with multiple problems would increase the length of the consultation.

Being aware of these factors can enable GPs to pay more attention to time keeping and implement strategies to help time management.

Managing time effectively

Start as you mean to go on
Arriving at the surgery early will allow time to settle in, have a drink, check emails, start the computer up, prepare for the first patient and start the surgery on time.

Adjust your booking intervals
If you are currently working with consultation booking intervals of less than 10 minutes, it may be worth increasing to a 10-minute slot if you find that you often run behind or finish late.

Improve your IT skills
Battling with the computer is a sure way to slow you down. Make sure you are familiar with the system and aware of any shortcuts that can be used.

Learning to touch type if you can not already do so can also save a lot of time.

Keep patients informed
Many patients are unaware of the length of the consultation they have booked. Informing patients when they book or through a poster in reception will help with their expectations of the consultation.

They should also be informed that they have the option of booking a longer or double appointment if they have a number of things to go through.

Book appropriately
If there is a patient who you know always makes you run late who is booking a follow-up appointment, encourage them to do so at the end of a surgery so it does not affect the rest of your appointments.

Multiple problems
A 10-minute consultation is not long enough to satisfactorily deal with a long list of problems, unless they are each very minor, which is usually not the case.

It helps if you can try to identify early on in the consultation whether the patient has come about more than just one thing. Allowing the patient time at the beginning of the consultation, using open questions and picking up on non-verbal cues, will help with this, as well as being direct and asking if there is anything else after the first problem has been presented.

The best thing to do when presented with a list of problems is to prioritise. Asking the patient which he or she considers to be the most important is one way of doing this, however sometimes it is clear that there is a clinical priority within the list.

Consider a polite way of asking the patient to reattend so that the other problems can be tackled. Most patients will be pleased that you want to spend time dealing with their problems effectively.

Ending the consultation
There are times when, despite the consultation clearly being over, patients continue to chat or prolong the consultation.

As long as the patient's needs have been met within the consultation, this is a time when breaking rapport is acceptable and necessary.

Ways to do this include breaking eye contact; altering your body position away from the patient; speaking faster and louder than the patient; sitting up straighter; handing over a prescription or patient information leaflet or starting to stand up. In some cases, it may even be necessary to stand up and open the door for the patient.5

  • Dr Kular is a locum GP in Nottingham

Learning points

1. Consultation times have increased over recent years.

2. Female patients, psychosocial problems, new problems and city-based practices all have longer consultation times.

3. Prioritise problems when patients attend with a list.

4. Be prepared to break rapport to end the consultation.

References

1. Review Body on Doctors' and Dentists' Remuneration, 27th Report 1998. London, The Stationery Office, 1998.

2. Transforming Primary Care: the Role of PCTs in Shaping and Supporting General Practice. London, Audit Commission, 2004.

3. Jenkins L, Britten N, Barber N et al. Consultations do not have to be longer. BMJ 2002; 325: 388.

4. Deveugele M, Derese A, van den Brink-Muinen A et al. Consultation length in general practice: cross sectional study in six European countries. BMJ 2002; 325: 472.

5. Moulton L. The Naked Consultation. A practical guide to primary care consultation skills. Oxford, Radcliffe Publishing, 2007.

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