Reducing consultation length

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Doctor torn between helping patients and meeting quotas

A trainee GP, passionate about helping his patients, struggled to manage his consultation time. He felt rushed and unable to give each patient the attention they deserved.

One day, after a particularly frustrating consultation, he approached his educational supervisor.

"I'm struggling with consultation time," he said. "I want to give my patients the best possible care, but I feel like I'm constantly rushing. Do you have any advice?"

The supervisor smiled. "I understand your frustration," he said. "Consultation time is a challenge for many GPs. But there are a few things you can do to improve it."

Factors influencing consultation length

Various factors can influence consultation length in general practice. Several studies have explored these factors and their impact on the duration of consultations. This synthesis will discuss the factors that increase or decrease consultation length in NHS primary care, drawing from relevant references.

One factor that consistently influences consultation length is the workload of the doctor. et al. Deveugele (2002) found that the length of consultations decreased as a doctor's workload increased. This suggests that when doctors have more patients to see, they may have less time to spend with each patient, resulting in shorter consultations. Similarly, Stevens et al. (2017) examined patient-level and practice-level factors associated with consultation duration in English primary care and found that workload was a significant factor. They reported that a higher workload was associated with shorter consultation durations.

The nature of the presenting problem can also affect consultation length. Hutton & Gunn (2007) conducted a systematic literature review and found that longer consultations in general practice were associated with improved management of psychological problems. They noted that these longer consultations allowed for more comprehensive assessments and increased opportunities for therapeutic interventions. Similarly, Lemon & Smith (2014) found that consultations for psychosocial problems tended to be longer, and increased consultation length improved the accuracy of diagnosing psychological problems.

The characteristics of the healthcare provider can influence consultation length. Das et al. (2021) found that doctors' gender, experience, degree of emotional exhaustion, and patient-centeredness were associated with consultation length in general practice. They reported that female doctors and those with more experience tended to have longer consultations. Additionally, Orton & Gray (2016) identified factors such as patient satisfaction, burnout, and professional referral and consultation as predictors of consultation length.

Patient-related factors can also play a role in consultation length. Mercer et al. (2007) found that more time for complex consultations in a high-deprivation practice was associated with increased patient enablement. This suggests that patients with complex health issues may require more time during consultations to address their needs adequately. Furthermore, Shepherd et al. (2019) reported that demographic factors, such as age and socioeconomic status, can influence consultation length and prescribing rates in general practice.

The type of practice and its characteristics can also impact consultation length. Schattner (2022) highlighted that consultation time in adult general practice is affected by various practice, physician, and patient factors and the type of problem being addressed. Factors such as staffing levels, rurality, and achievement of quality standards can influence the duration of consultations (Stevens et al., 2017).

Strategies to reduce consultation length

To reduce consultation length, trainee doctors can employ several effective strategies. These strategies are supported by various references that provide insights into consultation length and factors influencing it.

One strategy is to improve time management skills. Trainee doctors can learn to prioritize and allocate appropriate time for each patient based on the complexity of their condition Irving et al. (2017). By efficiently managing their time, trainees can ensure that consultations are not unnecessarily prolonged.

Another effective strategy is to enhance communication skills. Effective communication can help trainees gather relevant information from patients more efficiently, leading to shorter consultations (Deveugele, 2002). Developing active listening skills and using concise and clear language can facilitate effective communication and streamline the consultation process (Andersson et al., 1993).

Trainee doctors can also consider implementing shared decision-making approaches. Involving patients in decision-making can lead to more focused consultations and reduce unnecessary discussions (Sampson et al., 2013). By engaging patients in the decision-making process, trainees can ensure that consultations are patient-centred and address each individual's specific needs and preferences.

Utilizing technology and electronic health records (EHRs) can also reduce consultation length. EHRs can provide quick access to patient information, allowing trainees to review medical history and test results efficiently (Freeman et al., 2002). Additionally, using technology for appointment scheduling and reminders can help optimize time management and reduce delays during consultations (Das et al., 2021).

Seeking appropriate supervision and support from senior doctors can also be beneficial. Trainees can consult with their supervisors or mentors to discuss challenging cases or seek guidance on time management strategies (Sturman et al., 2020). Adequate supervision can help trainees develop their skills and confidence, leading to more efficient consultations.

Furthermore, trainee doctors can focus on building trust and rapport with their patients. Establishing a trusting relationship can facilitate open communication and enable trainees to gather necessary information more effectively (Baker et al., 2003). Patients who trust their doctors may also be more satisfied with shorter consultations if they feel that their concerns have been adequately addressed (Lemon & Smith, 2014).

Lastly, trainee doctors should prioritize self-care and manage their well-being. High-stress levels and burnout can negatively impact consultation length and quality of care (Wainwright et al., 2017). Taking breaks, practising self-care activities, and seeking support from colleagues and mentors can help trainees maintain their well-being and perform optimally during consultations.

Summary

Several factors can influence the length of consultations in NHS primary care. Workload, nature of the presenting problem, healthcare provider characteristics, patient-related factors, and practice characteristics all play a role in determining consultation length. Understanding these factors can help healthcare providers and policymakers optimize consultation durations to ensure quality care while managing the demands on primary care services.

The literature highlights several possible strategies to consider. From personal experience, what is essential is that it takes time. You need a good knowledge base, practical experience and advanced communication skills. Even with time, a lot of experienced GPs are running late.

“Nothing in the world is worth having or worth doing unless it means effort, pain, difficulty… I have never in my life envied a human being who led an easy life. I have envied a great many people who led difficult lives and led them well.”

― Theodore Roosevelt

Reference

Andersson, S., Ferry, S., & Mattsson, B. (1993). Factors associated with consultation length and characteristics of short and long consultations. Scandinavian Journal of Primary Health Care, 11(1), 61-67. https://doi.org/10.3109/02813439308994904

Baker, R., Mainous, A., Gray, D., & Love, M. (2003). Exploration of the relationship between continuity, trust in regular doctors and patient satisfaction with consultations with family doctors. Scandinavian Journal of Primary Health Care, 21(1), 27-32. https://doi.org/10.1080/0283430310000528

Das, M., Zakaria, M., Cheng, F., & Xu, J. (2021). Appointment length with patients in medical consultations in bangladesh: a hospital-based cross-sectional study. Healthcare, 9(9), 1164. https://doi.org/10.3390/healthcare9091164

Deveugele, M. (2002). Consultation length in general practice: cross sectional study in six european countries. BMJ, 325(7362), 472-472. https://doi.org/10.1136/bmj.325.7362.472 Deveugele, M. (2002). Consultation length in general practice: cross sectional study in six european countries. BMJ, 325(7362), 472-472. https://doi.org/10.1136/bmj.325.7362.472

Freeman, G., Horder, J., Howie, J., Hungin, A., Hill, A., Shah, N., … & Wilson, A. (2002). Evolving general practice consultation in britain: issues of length and context. BMJ, 324(7342), 880-882. https://doi.org/10.1136/bmj.324.7342.880

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Irving, G., Neves, A., Dambha‐Miller, H., Oishi, A., Tagashira, H., Verho, A., … & Holden, J. (2017). International variations in primary care physician consultation time: a systematic review of 67 countries. BMJ Open, 7(10), e017902. https://doi.org/10.1136/bmjopen-2017-017902

Lemon, T. and Smith, R. (2014). Consultation content not consultation length improves patient satisfaction. Journal of Family Medicine and Primary Care, 3(4), 333. https://doi.org/10.4103/2249-4863.148102

Mercer, S., Fitzpatrick, B., Gourlay, G., Vojt, G., McConnachie, A., & Watt, G. (2007). More time for complex consultations in a high-deprivation practice is associated with increased patient enablement. British Journal of General Practice, 57(545), 960-966. https://doi.org/10.3399/096016407782604910

Orton, P. and Gray, D. (2016). Factors influencing consultation length in general/family practice. Family Practice, 33(5), 529-534. https://doi.org/10.1093/fampra/cmw056

Sampson, R., O’Rourke, J., Hendry, R., Heaney, D., Holden, S., Thain, A., … & MacVicar, R. (2013). Sharing control of appointment length with patients in general practice: a qualitative study. British Journal of General Practice, 63(608), e185-e191. https://doi.org/10.3399/bjgp13x664234

Schattner, A. (2022). It’s about time: redesigning consultation length in general practice. Journal of the Royal Society of Medicine, 115(7), 276-278. https://doi.org/10.1177/01410768221102595

Shepherd, P., Krejany, C., & Jiwa, M. (2019). How does the duration of consults vary for upper respiratory tract infections in general practice where an antibiotic has been prescribed?. Family Practice. https://doi.org/10.1093/fampra/cmz058

Stevens, S., Bankhead, C., Mukhtar, T., Perera, R., Holt, T., Salisbury, C., … & Hobbs, F. (2017). Patient-level and practice-level factors associated with consultation duration: a cross-sectional analysis of over one million consultations in english primary care. BMJ Open, 7(11), e018261. https://doi.org/10.1136/bmjopen-2017-018261

Sturman, N., Tapley, A., Driel, M., Holliday, E., Ball, J., Davey, A., … & Magin, P. (2020). General practice trainee strategies for seeking in-consultation assistance from supervisors, and their perceptions of patient-related barriers to help-seeking: a survey study.. https://doi.org/10.21203/rs.3.rs-19806/v1

Wainwright, E., Fox, F., Breffni, T., Taylor, G., & O'Connor, M. (2017). Coming back from the edge: a qualitative study of a professional support unit for junior doctors. BMC Medical Education, 17(1). https://doi.org/10.1186/s12909-017-0978-0