Management of Time in the Consultation

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Management of Time in the Consultation

• Andrew Mowat

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Introduction

• The 10-minute Consultation
• Putting the genie back in the bottle
• Transition from GPR to Principal

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Overview

• Punctuality
• Controlling the Agenda
• Controlling the Time

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Punctuality

• Start on Time
• Set limits on lateness
• Minimise interruptions

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Controlling the Agenda

• Establishing ground rules
• notices, leaflets, education
• Looking for clues
• Defining the problem
• Opening Gambits
• Closing Gambits
• Exercise 1

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Exercise 1 the long list

• Mrs Smith, a 75-yr-old arthritic widow, is a
  frequent visitor to your Surgery. She comes in
  today after something of a long interval for her,
  and says
• Youve been so busy recently, I thought Id save
  a few things up for you to deal with all at once.

• Make it overt
• Set limits on todays consultation
• Establish a time when the rest of her agenda will
  be dealt with
• Educate her in ways of making appointments for
  multiple problems

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Controlling the Time

• Questioning
• open
• closed
• Body Language
• open
• closed
• Use of Resources
• Ending the Consultation
• Exercise 2

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Resources

• Time
• allows problem to evolve
• allows patients/doctors thoughts to clarify
• Investigation
• Referral
• Self-Help groups

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Exercise 2 the complex problem

• Mr White is a 40-yr-old Type 1 Diabetic. He has
  recently begun to feel excessively tired, has
  non-specific aches and pains, some sensory
  changes in his feet, and erectile dysfunction.

• Try and simplify the problem
• bite-size chunks
• Use of Time
• investigations
• referral
• trial of intervention
• medication etc

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Exercise 3 the late bombshell

• Miss Jones is a 16-yr-old new patient you are
  meeting for the first time. She has come to see
  you about her acne.
• After about 8 minutes of the consultation, she
  tells you she thinks she might be pregnant.

• Dont despair time isnt everything!
• Deal with the important things today
• wanted or unwanted?
• evidence for suspicion etc
• Arrange review for the unimportant things
  booking etc

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Ending the Consultation (1)

• Verbal
• summarising
• arranging review
• Physical
• posture
• getting up
• opening door
• the corridor consultation
• paperwork
• prescription
• letter, form etc

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Ending the Consultation (2)

• Last Resort
• walking out
• next patient
• asking for coffee
• telephone
• pager
• fire alarm

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Summary

• Overview
• start on time
• control the agenda
• control the time
• use resources
• end the consultation
• dont be afraid to run late

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Aspirations

• The 15-minute consultation
• Pendletons Seven Tasks
• Patient responsibility
• choose appointment length?
• Private Healthcare