Thursday, 11 October 2007

Consultation length

A recent article in the Careers section of the BMJ discusses appointment times, which has been a concern of mine. It mentions an Audit Commission report of 2004 which found that although planned consultation times of 10 minutes were common in England doctors actually spent longer with their patients, the median time being 13.5 minutes. I find that on a good day I average around 14 minutes per appointment, but things often take longer.

I had two contrasting morning surgeries this week. In the first half of my Tuesday morning session I started off in relaxed mood, but soon found myself dealing with many patients who had complex medical problems. These all had to be considered for the annual review, as well as the problem the patient had actually come about. And one lady was frustrating because she had many concerns and worries about her impending operation, which she explained at length and in rather poor English. By the time of the 10.40 appointment I was running an hour late, and there were many complaints in the waiting room. But in the second half of the morning the problems that patients brought were much simpler and I was able to deal with them briskly, though not I hope brusquely. My final patient was seen only 30 minutes behind time. It felt like a marathon (not that I have ever run one) - I saw 15 patients but it took just over 3.5 hours, which is an average of 14.6 minutes per consultation.

In contrast yesterday (and today) patients brought fewer problems and by pressing on I was able to keep to time, so that the patient with the 12 noon appointment was seen only 10 minutes late. For me the challenge is to keep up the momentum, using my consultation skills appropriately but efficiently, to do everything that has to be done and have a satisfied patient walking out of the door. The tricky part is to keep control of the conversation while not stopping the patient from saying what is really important to them. But keeping to time has so many benefits: I don't get stressed and tetchy, I feel efficient and energised at the end instead of resembling a wet dishcloth, and I have more time to deal with the next set of tasks.


The Shrink said...

But keeping to time has so many benefits . . .


When not keeping to time I get stressed.

To get information about an uncomfortable chest, say. Are symptoms suggesting cardiac, pulmonary, pleuritic, muscular, neuropathic, oepophageal, costochondral, bone or stomach as the site of pain, or is it referred from elsewhere?
Then to examine the chest adequately.
Then to handover the formulation/explanation.
Then to generate a management plan.
Then to explain investigations or treatments and side effects/risks and duration and alternatives and expected outcomes.
Then to safety net in case it is cardiac chest pain, describing what to do in what circumstances.

14 minutes for all that? And chest pain is something we're hot at, being well trained, well experienced and well rehearsed in.

Hats off to those of you who can consult so effectively in such a timely manner . . . you're a better man than me :-)

Dr Andrew Brown said...

Yes well, you have to compromise innit. :-)