Dr Seema Pattni looks to redefine the ‘slow’ GP label to one that values communication and attentiveness in a system that doesn’t always allow for it
Many GPs identify as ‘slow,’ but the negative associations of being a ‘slow’ GP need to change. The daily reality of being a slow GP is hard: over-running clinics, staying late at work, fatigue and frustration. You carry an unshakable heaviness of not being enough. Not just fast enough, but not good enough either. You are constantly trying to catch up with a workload that is continually topped up. All this weighs you down, and you end up feeling overwhelmed, stuck and burnt out.
As a trainee GP, you are often told that you need to be faster, more efficient and more resilient. This advice, while usually well meaning, adds pressure, and amplifies the constant inner voice detailing how inadequate you are.
Being a slow GP has multiple dimensions. I previously wrote about it being a gendered issue, with a wide evidence base demonstrating an imbalance in workload distribution, skewed towards female GPs having a larger workload. But, being slow is a label that can be felt by anyone. And one that I believe does not have to be negative.
The multi-dimensional slow GP
In the GP world of soaring demand, high expectations and enormous workload, speed is of the essence and the true value of a slow GP tends to be overlooked.
Slow GPs excel in thoughtfulness and empathy. They take longer because they listen deeply. They listen to understand; not just to respond – and the patient feels heard. Not only is this a therapeutic intervention in itself, but it also leads to better patient satisfaction and outcomes.
Slow GPs are conscientious. They are thorough and careful in: history taking; examination; referrals; prescriptions; record keeping; coding; and reviewing results and documents. This takes time but also reduces clinical error and medicolegal consequences, improving patient safety. A high proportion of patient complaints revolve around doctors’ communication: tone; pitch; speed; as well as choice of words (paralanguage.) Communicating deliberately and thoughtfully cannot be rushed.
Slow GPs are reflective and usually receptive to feedback and improving their performance at work. It is skilful to be efficient, but not at the expense of being an attentive and holistic practitioner, or losing your values.
The values conflict
Being slow, or rather thoughtful and thorough, enables many GPs to work in alignment with their values of compassion and care. This increases career satisfaction because when we work in line with our values we feel drive, purpose and fulfilment.
However, in the daily reality of general practice, speed naturally becomes a major metric of performance, and the qualities of a slow GP are underrated. Consequently, slow GPs continue working in overburdened environments which do not appreciate their strengths. Or, they change the way they practise and suppress their values. This decreases career satisfaction and also causes cognitive dissonance and burnout.
Redefining the slow GP
It is usually at this point, that as a careers coach, I meet slow GPs. Doctors who feel stuck and lost. Doctors who feel confused about why the career they thought was their calling, the career they have worked so hard towards, is creating so much distress and unhappiness.
And it is at this point, that we work on recognising the true value of being slow; redefining and reframing this skill set as a positive attribute, rather than bearing it as a burden. We work on understanding that it is often the systems and environment that we work in which are inefficient, not us. We work on accepting that it’s not such a bad thing to be slow.
It takes time and commitment to overcome limiting beliefs, and to detangle the negative narratives internalised through working in general practice. But it is worthwhile; it delivers renewed confidence and clarity.
The balancing act
Evaluating how we prioritise, delegate and manage time is important too. But doing this and working in accordance with your values can be challenging. There is a balance, and the tipping point towards burnout varies for each of us. Being able to recognise when you are near this tipping point is essential to burnout prevention.
Moving forward as a ‘slow’ GP
Acknowledging your worth as a ‘slow’ GP provides fresh perspective. You will be able to better identify practice teams which have the capacity to support you and your career progression. You will also realise that as a ‘slow’ GP you have a wealth of skills which position you well for portfolio and alternative careers.
The number of GPs pivoting careers is increasing and the uncertainty this creates for general practice is an ongoing concern. Something that is certain though, is that more and more GPs are redefining themselves, their pace and their work.
Dr Seema Pattni is a GP and careers coach for female doctors. Click here to find out more.
Once told a crowded Waiting Room ”I shall see every single one of you, even if it takes me ’til midnight
For many years in my appraisal I commented on running late. I felt I didn’t match my colleagues swift consults and completely admin tasks. But I couldn’t change. I bought a small digital clock as a reminder. That didn’t work. I sat leaning forwards during consultation as was told body language matters. I tried tying while consulting. Rushing a consult. Everything failed. I now consult in my natural way. I run late but I feel satisfied. But being a portfolio GP helps. I will always watch my colleagues in awe who are quick.
Don’t be a slow GP, and don;t be a fast GP either.
Much better to be a variable-speed GP who can adjust.
Learn to adjust – experience will learn you when you need to spend ages asking odd questions to uncover the hint to the uncomfortable feeling you had as they walked in that it was something serious, even though they only asked about some minute negligible thing.
Patients DO value a quick ‘no it isn’t serious – it’s normal’ when that is the case. Educate them respectfully, and they will also learn, and self-manage better in future : – but maybe spend a little longer the first time (maybe that is why trainees are slow, it is more often their first time meeting a patient) and they will feel they are getting to know you too.
Above all, notice and acknowledge them, as JGM says above, or something similar.
Ex-GP, 30+ years: this sort of GP is self-indulgent and dodges work, at the expense of other GP’s in my experience…
Amen to that. Exactly what i was about to say. But then i also agree with Patrick Young.
Ah, the good old “fast v slow” debate is back!!
I’ve always been baffled why slower consulters don’t simply extend their appointment times to match their speed. If a surgery always takes 4 hours, give yourself longer appointments, start earlier , and take the time pressure off. It’s also grossly unfair on patients if they rush to their 11am appointment only to be repeatedly seen at 1pm
And no, slower consulters should not have fewer appointments (before anyone suggests it). We’re not mugs. Faster GPs could and would easily decelerate to their speed, and inefficiency shouldn’t be rewarded.
Agree with David. Flexibility is the ideal. Fast when you think fast will do the job. Slow when you think a “deep dive” is required.
There’s a related question, not exactly speed but: how willing are you to invest time on patients who clearly want significant time with a clinician but seem unlikely to have medically serious conditions – EG the patient with non-textbook symptoms “it feels like a wave starting in my toes and moving up through my body. I can’t take deep enough breaths but there’s no rapid breathing…”
I tend not to spend a lot of time with these patients, but some of my colleagues do; and I don’t know who is “right”!
I let the patients decide how long they want to spend with me———–and still manage to finish pretty much on time
It’s not about being fast or slow, ffs. Different patients have different needs and 10 minute, one size fits all appointments are not fit for purpose. The system is broken and unpaid work and stress due to being ‘slow shouldnt be seen as a badge of honour but as a symptom of the broken primary cares system. No other country has such short appointments for today’s complex multimorbidities, it’s ridiculous and not about slow or fast GP’s.
You said ‘Slow GPs are conscientious. They are thorough and careful in: history taking; examination; referrals; prescriptions; record keeping; coding; and reviewing results and documents. This takes time but also reduces clinical error and medicolegal consequences, improving patient safety.’
Evidence please.
I’d like some evidence this is actually your opinion ‘just my opinion’ otherwise please don’t comment with unproven nonsense
Dr No is fast and slow. But I will say this… if being fast means one-problem consults then I’d rather be slow. This is a travesty that was forced on us which we now see as normal. Secondly I disagree with much of the above. Being slow when necessary is actually much less stressful, as I feel less likely to have missed something. Polysymptomatic and chaotic patients get cancer too.
@AB
How is asking for evidence of a claim ‘unproven nonsense’??
@Just My Opinion
Indeed my point entirely! Thank you
Basically I need a reference or some kind of proof for anything you say. Otherwise it’s nonsense. Yeah? Thats basically where you are with all this. Someone’s opinion is worth nothing unless someone else already did a study on it. Like Plato was an idiot? That kind of thing
I feel from patients perspective , they don’t want to be seen late due to their commitments , they don’t want to have too lengthy irrelevant chat with GP, rather they want quick solution . Slow GPs needs to change , no doubt , Good GP is safe GP, but with experience / exposure we need to tailor our speed , I believe it’s just like driving on motorway depending on situation/ case.
Some strong opinions here! Agree intelligent use of time is good, and making the right judgement. However I do feel a lot of the presssure to be “fast” and “run to time” is artificially imposed by the working environment (= politics/funding etc) and in trying to comply we have sold our medical souls. Observe the officially sanctioned “one problem” consults. Patients have really swallowed this and now won’t raise prob number 2 (and 3,4,5 etc) at all! This is poor quality medicine however you frame it.
@AB
Wrong.
I did not use the word ‘nonsense’, you did.
I did not say the ‘opinion was worth nothing unless someone did a study on it’. This is something you have invented and then decided was my opinion.
This is a published article making a claim that ‘slow’ GPs have less complaints, less medicolegal cases, better patient satisfaction, and that they are more thorough, compared to ‘normal speed’ GPs.
I did not say that was a good thing or a bad thing.
I did not say I agreed or disagreed with this statement.
What I did do was quote the section of the article which made the claim, and asked for evidence.
Anything else you have taken from that, is your own invention.
I’d say Dr Pattni’s article is thoughtful & caring and I’m sure she’s an excellent GP. Yes of course we need to vary our speed according to what the circumstances and the patient require. If we’re doing a very busy on-call day then we need to be as fast as is reasonably possible, for all concerned, but being fast all the time can lead to short cuts, poor notes, disappointed patients and poor coding/data quality. Be flexible and compassionate and yes, gently steer away from irrelevancies that will make no difference to the outcome for the patient.
Oh dear-my paramedics rattle through on time
@Just My Opinion
oh dear here i am again..I need evidence please. References, citations..your source. Thanks
The problem is, and I speak as someone who has a former partner who was slow in a small practice…..the other guys have to pick up the work to allow you to indulge .
That then forces them to work too quickly and increases their risk dramatically.
It would be wonderful if we lived in a world where there was enough GP time to allow individual doctors to spend lots of time with their patients….but the truth is , whilst one may pat themselves on the back that they are providing patient centred care, their partner is burning out. Never again. Having a very slow partner just dumps the work on to others , who then don’t have the luxury of giving their patients the time they need.
@AB
It’s not clear how you have made this all about yourself. No one can comment unless they first provide you with evidence that satisfies you? Very strange.
You made a foolish comment and were called out on it.
The best option is to let it go, rather than repost the same argument, which has already been discredited.
No “just my opinion” I was simply light heartedly pointing out an error in the logic of your original comment – where you make a long list of stuff from the article and then demand evidence. Like every statement requires a citation. It doesn’t. “Just my opinion” oh the irony. Thats me done. Apologies I’m just not a fan of this kind of sloppy thinking, it’s one of my many flaws, we all have many, no doubt you too. Peace
As long as the number of patients seen are similar to colleagues then no problem. It’s reasonable to allow longer appts in certain cases such as complex multimorbidities, minor ops, coils etc but this should be agreed. Having vastly different numbers of patient contacts will cause a lot of tension. Remember each contact generates additional work so the folk who are getting through the numbers will be punished. In general if it’s the same type of patients slow consulters should be allowed to work at their pace but expected to work longer hours to get through the numbers.