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GPs criticised for treating one condition at a time

A patient watchdog has criticised GPs for displaying signs telling patients that they will only deal with one condition at a time at routine consultations.

Aneurin Bevan Community Health Council (ABCHC), which monitors health services in South Wales, said some practices are continuing either to put up signs or to tell patients verbally that they will not deal with more than one condition at a routine appointment, despite previously being warned it was ‘clinically inappropriate and indefensible’.

However, the RCGP has argued that some practices are forced to make such rules to cope with heavy workloads.

The issue was raised at an Aneurin Bevan University Health Board meeting, where the ABCHC’s new annual report was highlighted.

The report states: ’Last year we drew the Health Board’s attention to the bluntly worded signs which we had observed in some GP surgeries indicating that only one medical issue could be dealt with in a routine GP consultation. We considered that such notices could inhibit patients from raising a number of symptoms which may be linked, and could discourage a fuller discussion which might assist an accurate diagnosis.

’The Health Board agreed with this view and the assistant medical director (general practice) communicated with all GP practices in the Gwent area to advise that a blanket policy was clinically inappropriate and indefensible.’

The board said that there has been a ‘reduction in this approach’, but that ’we are still seeing it continue in some areas’

It adds: ’While appreciating the time pressures in GP consulting rooms, we are concerned about the risk to patients if this issue is not fully resolved.’

But RCGP Wales vice-chair Dr Jane Fenton-May said: ’I can see where the CHC is coming from but this is one of the things that GPs have to do to regulate their workload. Some practices have been doing this for a long time.

’If a patient comes in with a shopping list of four or five things then sometimes you just have to tell them that you’ll look at the one that’s most important. Sometimes their problems are linked but sometimes they are not. We are limited to ten minutes per consultation, but the RCGP would like that to be longer.’

Dr David Bailey, Deputy Chair of the WGPC said: ‘GPs should treat holistically, although we understand that sometimes when providing urgent rapid access it may be important to clarify that the time slot is limited.

‘We would not support a blanket rule however, as sometimes a patients different problems are inextricably linked.’

NICE is currently working on guidelines for GPs dealing with multimorbidity, which are due next year.

Readers' comments (26)

  • It is impossible to sort out 5 significant and varied things in a 10 min slot and a variety of "proitisation" and "co-ownership/education" tactics are already suggested in the thread.
    As some contributers have said this group of patients are recognisable.
    Take it a stage further and you can time audit their consultation length.
    We massively improved our global patient satisfaction by identifying this few patients , placing a major alert their standard consultation was to be double or triple appointment slots whenever they requested"an appointment" reducing delays of subsequent patients- actually "bottoming out" and modifying some of the consultation behaviours.
    yes we have not sorted out the service pressures of too few doctors too little time however we did identify the game playing "consultation terrorist" subgroup of inadequate personality types whose motivation is to " screw up some authority figure so I feel better about myself" and derived satisfaction from "getting a better deal than others" and "making GP take notice and suffer".
    Where they decline to adress their negative personality traits in a theraputic model we find the Dr patient relationship has deteriorated and move them on.
    Yes they then see someone else , but may eventiually "get it" after sufficient Doctors and change their ways- or the Nice Guidance on "management of Patients with Physical symptoms without Organic basis " may be resurected- its 0 years in development.

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  • I sometimes wonder if GP's want to bother with patients at all?
    GP's are really losing the support of patients, double appointments should be bookable and in the long run, it will save time. Sometimes problems are linked, you cannot deal with one without taking the other into consideration. Care should mean care, and patients will often return when they are anxious that something is being missed, which appears to be quite often theses days!
    Some appointments take a minute or two, others longer but they should balance out at the end of the day.
    GP's need to decide which is more important, care of the patient or clock watching!

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  • Other Health Professional 11:17 you need to read Zoe Norris' letter to her daughter on Huffington Post. Care of the patient v having a life is tipped so far against having a life my ability to care is fast waining.

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  • I don't like these signs either. Not because they're stopping us from making diagnoses (if we're even half-decent clinicians we'll elicit the relevant information) but because they actually encourage the behaviour that they're intended to discourage. What patients see is, "These signs mean that LOTS OF OTHER PEOPLE have been going into the doctor with a list of problems, therefore this is NORMAL BEHAVIOUR, so I can do it too."

    And I've had a patient come in and tell me that they've seen the sign but realise it's not meant for "people like them". I'm still scratching my head about that one.

    Unfortunately, we sometimes don't know which patients are genuinely consulting about their dandruff and which are going to say, after spending eleven minutes of a ten-minute slot perseverating about their dandruff, "Oh, by the way, doctor, is it normal to have blood in your poo?" or burst into tears and disclose domestic abuse.

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  • The principle of discussing one condition at a time is reasonable given the current workload. The history taken of the symptom discussed would of course bring out any other symptoms of relevance. This is indeed the principle of the D of H 111 system - they triage one symptoms and thee triage process brings out other relevant co-existing symptoms- why can GPs not do the same??

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  • Difficult topic.

    Clearly there may be linked symptoms, and I think we would all agree that if a patient comes in with a list, we can manage that.

    The difficulty is when you use your ten minutes wisely, only for the patient to say "whilst I am here..." and for some reason it is almost always benign sounding chest pain. I am certain some people leave more serious sounding problems till later on purpose.

    I agree "one appointment one problem" sounds too restrictive but would be nice if patients had a better grasp of how our timings work and could present a list of bullet points to allow us to prioritise.

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  • @11:17

    Giving patients the ability to book double appointments will clearly reduce the number of patients who can be seen in a day.

    So it will be benefiting those patients who manage to book the double appt at the expense of those who fail to get any appointment.

    My sense of justice suggests it's more fair to give a larger number of patients a small amount of time than a smaller number of patients a larger amount of time (and the rest no time at all).

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  • Anonymous | Other healthcare professional07 Oct 2015 11:17am

    I agree with you that double appointments are sometimes needed. However, you clearly have never worked in a GP practice, as in my experience 90% of people who want more than one problem dealing with don't tell the receptionist and don't even ask for double appointments, even when they are bookable.

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  • I am sick and tired of being criticized by those who have no clue about what we do. They will realise what damage they are causing when its to late. Human nature I'm afraid.

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  • Anonymous | Other healthcare professional07 Oct 2015 11:17am

    GP's need to decide which is more important, care of the patient or clock watching!

    What absolute tosh! I care about ALL my patients, means balancing my time as best I can and the way I see fit. You want the honest answer? We will bother with patients more when we start to feel more appreciated, by patients and the government. If patients aren't happy? Wait til we're private and you have to pay market rate for our expertise, or if you're happy to see a noctor, nurse, PA, pharmacist, go right ahead. Here's the honest truth, the majority of GPs are overworked, and we are ALL clock watching to stay sane.

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