GP training: How to master the ten-minute consultation

Dr Patrice Baptiste offers some tips for GP trainees on conducting consultations within ten minutes.

(Photo: sturti/Getty Images)
(Photo: sturti/Getty Images)

I think it’s fair to say that a lot of GPs struggle with sticking to a ten-minute consultation. It depends heavily on what the presenting complaint is. For instance a fit note or minor illness could easily be  managed in under ten minutes, however if it is a more complex, elderly patient with several co-morbidities ten minutes may not suffice.

Below are some tips to help you learn the art of consulting in ten minutes.

Build a rapport

With growing patient lists it can be near impossible to meet and know every single patient registered at our surgeries. However, when meeting a patient for the first time it is crucial to work on building a rapport.

This can be difficult for a variety of doctor, patient and other factors. But, I have found that taking the extra time, even if it means running behind at the start, will help save time overall in the future. It builds trust, which should help save time during any future appointments with the patient, and hopefully ensures they do not book another appointment with someone else because they were not satisfied.

Stay focused

With experience it is much easier to treat patients within the ten-minute slot. A key component of this is knowing how to stay focused. By this I mean focusing and knowing how to select key parts of the patient’s history and which examinations are pertinent.

Of course great skill is needed to ensure that the patient feels listened to and not rushed into wrapping up the consultation. Starting with open questions and then honing in using closed questions is a great way to do this.

Signposting also helps the patient understand what you are going to discuss next and why it is important; this saves time because it prevents (hopefully) the patient stopping and asking you why you have asked that particular question.

A good example of this is signposting patients about the red flags of back pain – suddenly jumping to bladder and bowel disturbance may not make any sense if they can’t make the connection with their back pain.

Follow up

One of the best things about general practice is the ability to follow patients up and the continuity of care that can be provided. The consultation should not be seen as something in isolation but as a series of encounters all linking together in time. By viewing it in this way much can be achieved within a short space of time, including patient satisfaction.

With several of the patients I see regularly for various reasons I am able to manage their problems and sometimes multiple problems within ten minutes because I ‘know them’ and can use previous consultations to essentially pick up where I left off.

If you do not have time to cover everything in one appointment then booking an appointment in the future can be a great way to ensure you do not run behind and your patients do not feel rushed or not heard.

Delegate

One thing I use without fail is other team members’ expertise and support. Examples of this include asking the receptionists to direct patients to certain services or the practice website or using the secretaries to refer patients to local hospitals or enquire about services I may not know about.

Be safe

Making sure that you always ask about red flags early on really helps differentiate quickly what is serious and needs emergency treatment or an urgent referral instead of something that may need a routine referral or a ‘watching and waiting’ approach. When someone comes in with ear pain, you can very quickly determine if this is something serious or not just by asking a few simple red flag questions.

Again, like the above point it does take some skill to get these questions in early without seeming to rush the patient or not listening to them.

Of course we all have a lot to do as GPs and want to stick to time, but ensuring that we truly listen to patients and provide them with the best care possible is more important and is definitely worth running over.

  • Dr Patrice Baptiste is a London-based portfolio GP. She has also founded a medical careers company called DreamSmartTutors.

More consultation skills articles on GPonline

Have you registered with us yet?

Register now to enjoy more articles and free email bulletins

Register

Already registered?

Sign in

Follow Us:

Just published

GP workload fears over antibody testing rollout for 'no clinical benefit'

GP workload fears over antibody testing rollout for 'no clinical benefit'

GP practices are being contacted by patients asking for antibody tests as the government...

Top GP spells out actions to protect BAME staff after PHE review fails to offer solutions

Top GP spells out actions to protect BAME staff after PHE review fails to offer solutions

The BMA's top GP has spelled out the advice and support practices need to protect...

GP time per patient slumps to lowest level in half a decade

GP time per patient slumps to lowest level in half a decade

GP time available per patient has dropped by six and a half minutes since 2015 -...

An uncompromising defender of the NHS: colleagues remember Dr Ron Singer

An uncompromising defender of the NHS: colleagues remember Dr Ron Singer

Colleagues and friends have paid tribute after the death of East London GP Dr Ron...

COVID-19 death rate highest among BAME groups, delayed PHE review confirms

COVID-19 death rate highest among BAME groups, delayed PHE review confirms

Death rates from COVID-19 are highest among patients from BAME groups, according...

GPs face hundreds of complaints over shielding and PPE during pandemic

GPs face hundreds of complaints over shielding and PPE during pandemic

GP practices have faced hundreds of complaints over issues including shielding and...