Negotiating the list

Get the full list out early
Prioritise –  what and when
Be ready for the doorstopper

Consultations usually overrun because they cover too many problems or take too long over each problem for the appointment time allocated. Bear in mind a ten minute appointment gives you seven minutes consultation after allowing for record reading, writing and administration. The doctor needs to be clear what is on the agenda for discussion so that they can focus and allocate sufficient time to each problem.

Get the full list out early

After a welcome and the offer by the patient of the main problem it helps to ask ” are there any other problems?” Your aim is to get the full list of problems out and either noted on the screen or on paper. Ask if “that is all or if there is anything else not yet mentioned?”. This might be perceived as a risky strategy as it encourages more problems to be discussed in a short time. However those problems already exist in the patients mind so it is better to get them out in the open, to help you plan your approach and ensure your have at least acknowledged their existence.

Add to this list the things you have to do as a doctor, which may relate to existing medical problems or to external targets such as blood pressure recordings or health checks.

Prioritise –  what and when

Having established a shared list of problems the aim is to negotiate which of these you will deal with today and which you need to defer to a later appointment. You may be able to identify some simpler quick tasks to do and one which needs more time but is still achievable in the time allowed. You can openly discuss this and explain why you will have to be quicker on one area more than another. The more serious and risky problems will need to be addressed early. People often seem to mention chest pain or bleeding or depression or sexual problems last.  Perhaps because they are most worried about them or embarrassed. The aim is to bring the serious forward to address them early on.

Be ready for the doorstopper

Often, as the patient leaves, they add in another problem that has come to mind. If you have negotiated your list well, at the start, this will happen less often.
Check it is safe to defer. Explain you have run over time and say that it was not mentioned at the start. Apologise and offer a review. You are in a much stonger position to say no as you have negotiated from the start of the consultation. Starting to negotiate at the end of the time allowed for the consultation is too late.  At this point your focus needs to be on the next patient and allowing time for you to recharge and refocus. For other tips on time management see under downloads and scroll down to “consultation length”