This is an important and relevant topic that is of concern to GPs and Practices every day. Irrespective of the duration of a consultation, the crux of the matter is the number of problems that can safely and effectively be dealt with in a single encounter. There is an inherent conflict between the need for access to primary care and the need to provide safe practice.
It is ludicrous to expect that all problems can be safely managed in a single consultation of even 30 minutes, unless they are all small and largely self limiting. What happens is that some issues are dealt with superficially or politely deferred for another day. It is better and safer to prioritise and deal safely with those that are clinically important (may not be those which are important for the patient) and request another appointment for remaining issues. To muddle though under pressure, becoming even later with subsequent appointments, some of whom again may have multiple issues is a recipe for disaster. In a population that is increasingly associated with multi-morbidity there has to be a prioritisation of services. I also find it absurd that I provide the same time for a patient with sore throat as for someone who has been just discharged form hospital having had coronary stents inserted and with the need to discuss his condition, medication, employment etc!
Primary care needs an investment in doctors, nurses, nurse practitioners etc if we are to begin to have the time to cover the multiplicity of problems that a patient may bring to a consultation.
For many years I have been providing care on the ‘one consultation one problem’ basis. So long as the policy is known to patients and is applied flexibly, problems seldom arise. I have not encountered any and I have often dealt with more than one problem when time permits. In those instances when time is at a premium I advise the patient to make another appointment or make one myself, if considered important.
Additionally, this topic is relevant to the need for a face-to-face encounter. The ‘smart’ use of consultations for those that need it may help reduce pressure on appointment systems. The provision of telephone access for matters as diverse as discussing test results, outcome of hospital visits, some modifications to medicine routines etc helps with availability of appointments to those who need them most.
Rapid Response:
Re: One problem
This is an important and relevant topic that is of concern to GPs and Practices every day. Irrespective of the duration of a consultation, the crux of the matter is the number of problems that can safely and effectively be dealt with in a single encounter. There is an inherent conflict between the need for access to primary care and the need to provide safe practice.
It is ludicrous to expect that all problems can be safely managed in a single consultation of even 30 minutes, unless they are all small and largely self limiting. What happens is that some issues are dealt with superficially or politely deferred for another day. It is better and safer to prioritise and deal safely with those that are clinically important (may not be those which are important for the patient) and request another appointment for remaining issues. To muddle though under pressure, becoming even later with subsequent appointments, some of whom again may have multiple issues is a recipe for disaster. In a population that is increasingly associated with multi-morbidity there has to be a prioritisation of services. I also find it absurd that I provide the same time for a patient with sore throat as for someone who has been just discharged form hospital having had coronary stents inserted and with the need to discuss his condition, medication, employment etc!
Primary care needs an investment in doctors, nurses, nurse practitioners etc if we are to begin to have the time to cover the multiplicity of problems that a patient may bring to a consultation.
For many years I have been providing care on the ‘one consultation one problem’ basis. So long as the policy is known to patients and is applied flexibly, problems seldom arise. I have not encountered any and I have often dealt with more than one problem when time permits. In those instances when time is at a premium I advise the patient to make another appointment or make one myself, if considered important.
Additionally, this topic is relevant to the need for a face-to-face encounter. The ‘smart’ use of consultations for those that need it may help reduce pressure on appointment systems. The provision of telephone access for matters as diverse as discussing test results, outcome of hospital visits, some modifications to medicine routines etc helps with availability of appointments to those who need them most.
Competing interests: No competing interests