Primary care

Patients' perceptions of entitlement to time in general practice consultations for depression: qualitative study

Kristian Pollock, concordance research fellow,  Janet Grime, concordance research fellow. 

Department of Medicines Management, Keele University, Keele ST5 5BG

Correspondence to: K Pollock
k.pollock{at}keele.ac.uk

Objective:: To investigate patients' perceptions of entitlement to time in general practice consultations for depression.
Design:: Qualitative study based on interviews with patients with mild to moderate depression.
Setting:: Eight general practices in the West Midlands and the regional membership of the Depression Alliance.
Participants:: 32 general practice patients and 30 respondents from the Depression Alliance.
Results:: An intense sense of time pressure and a self imposed rationing of time in consultations were key concerns among the interviewees. Anxiety about time affected patients' freedom to talk about their problems. Patients took upon themselves part of the responsibility for managing time in the consultation to relieve the burden they perceived their doctors to be working under. Respondents' accounts often showed a mismatch between their own sense of time entitlement and the doctors' capacity to respond flexibly and constructively in offering extended consultation time when this was necessary. Patients valued time to talk and would often have liked more, but they did not necessarily associate length of consultation with quality. The impression doctors gave in handling time in consultations sent strong messages about legitimising the patients' illness and their decision to consult.
Conclusions:: Patients' self imposed restraint in taking up doctors' time has important consequences for the recognition and treatment of depression. Doctors need to have a greater awareness of patients' anxieties about time and should move to allay such anxieties by pre-emptive reassurance and reinforcing patients' sense of entitlement to time. Far from acting as "consumers," patients voluntarily assume responsibility for conserving scarce resources in a health service that they regard as a collective rather than a personal resource.

What is already known on this topic A widespread concern is that pressure of work is reducing the length of general practice consultations and that doctors can't deal adequately with patients' problems in the time available Little is known about patients' experience of time in consultations What this study adds Patients with depression feel under such acute pressure of time that they are often inhibited from fully disclosing their problems, preventing them making best use of the consultation There is often a disparity between patients' sense of time shortage and the amount of time their doctors are willing and able to provide Doctors should be more aware of patients' anxieties about time and allay these anxieties by providing pre-emptive reassurance as a means of reinforcing patients' sense of entitlement to consultation time