Face to face
Appointment length has increased over the last 20 years in most general practice surgeries. Five minute booking slots have moved to ten minutes, but the number of tasks within the consultation has increased as doctors address increased patient agenda and doctors agenda. Proactive chronic care demands have added to handling the presenting problem
Most people do not appreciate that a ten minute booking slot only gives about seven minutes of face to face time becasue there is much more to do and that can be done before and after the actual meeting
Computer systems now give much more informaiton about medical problems, medications, previous managemnt and the wider family. It requires a minute to review these and identify what are the key issues. Are there outstanding medication reviews, chronic disease checks, smear reminders, results to inform or basic tagets on recording smoking, or blood pressure. When a patient walks in a proactive GP will have these things in mind and be ready to move these areas forward as well as dealing with the presenting problems
Face to face
Seven minutes is the time in which a doctor needs to establish a relationship, be told the main problem, identify any other problems, negotiate what will be done, take a full story, do a physical examination, discuss the cause, explain the treatment options, reach a shared agreed plan, advise on follow up and then say goodbye. It is a lot to pack in to seven minutes especially if this has to be repeated for each presenting problem.
After the patient leaves the room a medical record needs to be made. This may have been started during the discussion but there will be some round up points. The problem lists may need editing and a template for one disease or other may need to be completed. Dictation of letters may fit into this time slot depending on what the doctor prefers.
The doctor then needs to check they can move onto the next person safely and there are no other outstanding issue. The doctor may need to address how they feel before the next patient comes in (see emotional awareness). An angry or depressed patient can transfer their feeling to the doctor which can be tiring.
The doctor needs to be able to close the consultation fully and move onto the next of some 30 to 50 consultations over that day (see corridor of consultations).
For other tips on time management see under downloads and scroll down to “consultation length”