Management of Time Management of Time in the Consultationin the Consultation

Andrew Mowat

Introduction Introduction

The 10-minute

Consultation

Putting the genie

back in the bottle

Transition from

GPR to Principal

OverviewOverview

Punctuality

Controlling the

Agenda

Controlling the

Time

PunctualityPunctuality

Start on Time

Set limits on

lateness

Minimise

interruptions

Controlling the AgendaControlling the Agenda

Establishing ground rules– notices, leaflets, education

Looking for cluesDefining the problemOpening GambitsClosing GambitsExercise 1

Exercise 1: the long listExercise 1: the long listMrs 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:

“You’ve been so busy recently, I thought I’d save a few things up for you to deal with all at once”.

Make it overt Set limits on today’s consultation Establish a time when the rest of her agenda

will be dealt with Educate her in ways of making appointments

for multiple problems

Controlling the TimeControlling the Time

Questioning– open– closed

Body Language– open– closed

Use of Resources Ending the

Consultation Exercise 2

ResourcesResources

Time– allows problem

to evolve– allows

patients/doctors thoughts to clarify

Investigation Referral Self-Help groups

Exercise 2: the complex Exercise 2: the complex problemproblemMr 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

Exercise 3: the late Exercise 3: the late bombshellbombshellMiss 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.

Don’t despair: time isn’t everything! Deal with the important things today

– wanted or unwanted?– evidence for suspicion etc

Arrange review for the unimportant things: booking etc

Ending the Consultation (1)Ending the Consultation (1) Verbal

– summarising– arranging review

Physical– posture

getting up opening door “the corridor

consultation”– paperwork

prescription letter, form etc

Ending the Consultation (2)Ending the Consultation (2)

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

SummarySummary

Overview– start on time– control the agenda– control the time– use resources– end the consultation– don’t be afraid to run late

AspirationsAspirations

The 15-minute consultation– Pendleton’s Seven

Tasks Patient

responsibility– choose

appointment length?

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