The effective consultation
The average patient visited their GP, on average, 5.5 times per year in 2008/09
Your main communication with patients will be during surgery consultations. The average patient visited their GP, on average, 5.5 times per year in 2008/09. www.ic.nhs.uk
Communicating well could even save you from receiving a complaint. The General Medical Council (GMC) warns that patients who have lodged a complaint deserve "a prompt, open, constructive and honest response including an explanation and, if appropriate, an apology”. Page 7 has more information about being open when things go wrong.
Against the clock
Research shows that a focused history and examination will indicate the diagnosis in about 75-80% of cases
GP consultations have lengthened over the years. The average consultation time rose from 8.4 minutes in 1992 to 11.7 minutes in 2006, when the last statistics were published. www.ic.nhs.uk
In this time, you need to establish a good relationship with the patient, communicate effectively, and make an accurate diagnosis. Research shows that a focused history and examination will indicate the diagnosis in about 75-80% of cases.
The consultation has been described as a “meeting between experts”– the doctor is the expert in diagnosis and disease, and the patient is the expert in their own symptoms and experiences (Tuckett et al 1985).
It is important to let the patient talk first, and not to interrupt. If you allow a patient to talk, uninterrupted, and explain why they have come to see you they will, on average, talk for 90 seconds. In addition, almost 80% of patients will finish within two minutes. Only 2% would keep on talking for more than five minutes, given the chance. Langewitz W et al, Spontaneous talking time at start of consultation in outpatient clinic, BMJ 325:682–3 (2002).
Patients who are denied the opportunity to explain their concerns or reasons for presenting may feel alienated, frustrated or resentful. Patients who are kept informed about their condition, and who are actively involved in deciding on the appropriate treatment, are more likely to comply with suggested treatments and are less likely to complain if things go wrong.
Watch out for the unusual
When caught off guard, it is important to maintain your professionalism
Working in general practice, you will now be seen as part of the local community. Your relationship with patients is not restricted to the confines of the consultation room, and you will find that there are numerous additional demands on your time, eg, the practice nurse asks you to have a quick chat with a worried mother before her daughter has her MMR jab. When caught off guard, it is important to maintain your professionalism.
Make sure that you treat informal situations professionally and write up a note of the encounter in the patient’s records. You may meet patients socially, for example in the local newsagent or pub. Unless it is an emergency, you should advise them to get in touch with the surgery to make an appointment, where records and results are to hand.
Tips for an effective consultation:
- Let the patient talk first. An uninterrupted history aids diagnosis.
- Use non-verbal communication to encourage patients to talk, eg, nodding, making and maintaining eye contact
- Well-aimed open questions can help “lead” the consultation
- Allow patients enough time to ask questions and clarify things
- If there is a lot of information for patients to digest, use patient information leaflets or factsheets.