Dr Copperfield on how long a 10-minute consultation can really take
Why do I always run so sodding late? I’ve analysed one typical consultation to find out:
Element of consultation Time taken Check of notes prior to calling the patient in, just in case when I ask her how her husband is, she says ‘dead’ 30 secs Walk to the waiting room because the automatic call-in display has frozen on a ‘Have you got chlamydia?’ public information message again 30 secs Walk back from waiting room 1 min (slower because I’m having to keep pace with my 80-year-old patient and also answer her questions about whether or not she needs chlamydia screening, which I’d have thought not, although this is Essex, remember) Listen to harangue about how long she had to wait for this appointment 1 min Listen to harangue about how long she has been kept in the waiting room 1 min Listen to loaded comments about how nice it is to ‘actually see a GP at last’ 1 min Gnaw my knuckles over the last 3 mins 1 min Respond to her query, ‘How are you, anyway, doctor?’ 1 sec Argue over how many of the list of six problems she has brought today we can reasonably deal with 5 mins Discuss how we have spent so long reaching agreement that we might be able to deal with four items that now we only have time for three 2 mins Discuss and assess her three problems 15 mins At her request, check her BP 5 mins, allowing for it inevitably being up first time and so needing repeating At her request, check her weight 3 mins allowing for the fact that she insists on me converting kg into imperial Deal with QOF pop-ups 3 mins Deal with IIF pop-ups 3 mins Remind her about flu jab and listen to various spurious arguments from her as to why she won’t have it, including but not restricted to, it all being about us hitting targets (true) and how she got flu from the jab last year (not true) 5 mins Deal with medication usage review pop-up 3 mins (20 secs per medication) Respond to her comment that she has read that she’s supposed to be on a statin by ‘exploring her beliefs about what determines future health, assessing her readiness to make changes to her lifestyle, undergo investigations and take long-term medication, assessing her confidence to make changes to her lifestyle, undergo investigations and take medication, informing her of potential future management options based on current evidence and best practice, involving her in developing a shared management plan and checking that she has understood what has been discussed.’ 10 mins Wait for her to ask, ‘Well, you’re the doctor, you tell me’ 1 sec Tell her to forget it 1 sec Agree to issue her repeat prescription while she is here 1 min Swear because my computer has crashed 2 mins Reboot my computer 4 mins Re-do the repeat prescription 1 min Clear pop-up reminding me to co-prescribe a PPI because I’ve prescribed an NSAID, even though it was topical ibuprofen 30 secs Listen to her say, ‘Anyway, that’s not why I came, it’s about my urinary incontinence’ and start the consultation over 15 mins Print form and label bottle for urine test 3 mins Explain to her how to do the test, where to drop it off, how to get the result, what to do about the result, how to get a follow-up appointment because it’s so difficult to get an appointment 3 mins Safety net all of the above 3 mins Say goodbye 1 sec Seek and eventually find air freshener 2 mins Deal with same patient poking her head back around the door mid-spray saying, ‘While I’m here, what was the result of my last blood test?’ 2 mins Write up notes in patient-comprehensible and inoffensive way 5 mins Have a little lie down 2 mins
Total: 1 hr 44 mins and 33 secs. So, that’s your answer. I run late because the 10-minute consultation lasts almost the length of my entire surgery. Next patient, please. God, no.
Dr Copperfield is a GP in Essex. Read more of his blogs here
Priceless!
Totally brilliant 🤣
So true :)))
Wonderful!!
Hey Tony – truly inspired. The “20 seconds per medication” the high point. Oh and the air freshener moment… we’ve all been there. I reckon you’re actually one of those docs the patients all love, who really do go the extra mile, who will gamely take 4 problems on at once, who really will do all that crap you listed above. When you and me retire, General Practice is truly dead. Keep smiling.
It’s hard if not impossible to practice medicine satisfactorily in UK NHS general practice. The absurdity of the 10 minute appointment needs to be consigned to a bin. 2 minutes for the patient to walk down to your room, 6 minutes consultation time for 3 or more problems and 2 minutes to record notes which now need to be an essay from a medicolegal perspective.How much more can you add on to the consult? We are now dealing with increasing complexity and multimorbidity, push back from secondary care and increased. medicolegal risk. It is the 10 minute consultation with its limitation which is a core reason for stress and burnout. You really can’t do the job properly! Minimum appointment times should be 20 minutes now, However given the workforce crisis and the politically unpalatable trade off with volume and access, along with contractually needing to provide appointments to “meet the reasonable needs of the patients”, this will never happen. We are our own worse enemy. We will keep plugging away despite the unacceptable risky position and continue overrunning clinics, doing quick fixes (which doesn’t help the patient or GP) and trying the impossible. The job as it is, is a complete turd.
Hilarious but very true!
May I recommend a chart, converting kg to stone, in large font, right in front of your scales? Not only does it save you doing the conversion yourself, but it buys you valuable note-recording time while the patient argues with the chart and scales that “That can’t be right”.