No waiting

At our partners' meeting last week we discussed the results of our Patient Participation Survey. Several lucrative Brownie Points are available for carrying out this discussion and taking action on the points raised.

In general, our scores were on a par with national average scores (from two years earlier), with one glaring exception - time spent waiting in the waiting room. There is a conflict between giving enough time to explore patients' worries, treating them holistically, and carrying out all the new health promotion work, and then getting them out of the door in the allotted time. Predictably we scored higher than average for "ability to listen", "explanation", "able to express concerns", "respect shown", "consideration" and "concern for patient". Ironically we scored lower than average for "time allotted to visit", which demonstrates the classic human trait of wanting to have your cake and eat it.

The older partners consult more leisurely, but our keen young partner (who isn't burdened by 1980s touchy-feely ideas about general practice) keeps strictly to time and is frustrated by patients who arrive late. He scored less well on his personal characteristics, but is appreciated by people who want to be dealt with efficiently and not kept waiting. In that respect he is very much like the senior partner here when I joined the practice. Plus ça change...

During my recent appraisal, my appraiser told me that he used to be a "touchy feely" GP who always ran terribly late. He realised that his patients were becoming dependent on him and that this was not healthy. He tried to speed up his consulting, but the patients wouldn't let him. In the end he took the drastic step of moving to a new practice. He now keeps strictly to time. When patients start another long description of their depressive symptoms he says "yes, but what do you want to do about it?" Interestingly he said that he doesn't like his new persona as much as the old one, but he can live with it.

Moving practice is not an option for the older partners, who will be retiring within a few years. And they acknowledge that they are unlikely to change their consulting style at this stage of their game. For my part I will try to be more directive in my consultations, using the "shopping list" approach of defining the agenda right at the start of the consultation. My concern is that patients may be less satisfied by short consultations and as a result may consult more often because their worries have not been met. But there are many other factors affecting consultation rates, and our rates have not changed greatly for many years. We shall see.

And the action plan that arose from our discussion? We will put a poster in the waiting room reminding patients that their appointment is only for 10 minutes. Which in my opinion will achieve nothing useful whatever.