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.
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.
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.
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.
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.