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Dear patient, the whole problem is the ten minute consultation

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Dear patient,

I know you hate it when I tell you that we only have ten minutes and I can’t therefore deal with multiple problems. Or that because you are eight minutes late that unless its something quite straightforward you will have to rebook, but there are reasons.

In that ten minutes, just think what has to happen

The entire problem is the ten-minute consultation.

Firstly, it isn’t just your ten minutes that I have, it’s the ten minutes for the patients crammed either side of you. In fact, in the three hours that I see patients, there are 18 patients with ten minutes each, them with me and me with them. That’s right, three hours, 18 patients back to back and no break.

In that ten minutes, just think what has to happen. Firstly you have to get to me from the waiting room, for some this takes two or three minutes. For the old, disabled, mums with  kids, people in pain, it takes time. So now I have eight short minutes to listen to you, ask questions, look at previous notes and start formulating a plan.  I may have to do an examination, get you up on the couch, get a urine sample, test it and then decide what to do. You could need a prescription, some instructions and what to look out for. It may also involve one or even two referrals. That means a typed letter and possibly a booking through an electronic system. Oh and then I have to write your notes, and those should be as detailed and accurate as possible because I know it helps the next doctor you see and saves you the frustration of repetition. Imagine doing all of this properly and thoroughly in ten minutes? Then imagine the same process for each of the ‘just a few things’ that you would like to discuss with me today. Then imagine doing it 18 times on the trot.

While all of this is going on there are telephone calls, results from the day before to check and action, documents coming in constantly from hospitals and other professionals that need action. Sometimes I even have to go to the toilet.

A friend of mine who is not a doctor seemed to feel that I was over-egging it and the only comparison I could draw that seemed to resonate was this: imagine you were at a job interview putting your best you forward and having to be at the top of your game. Then imagine a bell ringing at ten minutes and the interviewer walking out and a brand new one arriving and you had to start all over again, 18 times.  Would you be as fresh at the 18th as you were at the first? What if you had to type up some notes at the end of each interview and maybe a letter or two? Could you, and run on time? And if you choose to run late, are you happy for that to encroach into your personal time, to not get home in time to see your kids or go to the gym?

So what is my message? Well firstly, it’s not deliberate. The pressure from the Government to deliver endlessly more appointments have led to the introduction of the ten minute consultation. Secondly, whichever kind of GP yours is, whether they run late or on time, please understand that they are trying to do their best by you. They have either chosen to do that by dealing with everything and running late or keeping to time and limiting problems. They are also human and need to drink, pee and have time with their families and to relax. And if you feel really strongly about it, write to your MP, please.

Yours faithfully,

Your tired GP

Dr Renee Hoenderkamp is a first-year qualified GP in north London. You can follow her on Twitter @DrHoenderkamp

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Readers' comments (13)

  • I feel your pain

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  • Very eloquently written. Thank you for putting into words what most of us, I suspect, are thinking when we hear the words "there's a few things", sometimes followed by the justification of "I don't come in very often" when we explain it isn't safe to deal with multiple problems in a single consultation. I think the RCGP should use this in a campaign to inform patients, but I'm certain they wouldn't have the nerve to say anything as sensible as this.

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  • I wholeheartedly agree with you that short appointments are a huge problem. I would add to this as an equally great problem the unrealistic expectation of many patients and the medicalisation of non-medical problems. I walked away last year, just had enough of the whole picture, uncontrollable demand, poor media and political perception, increasing litigation etc. I fear greatly for the NHS but good luck to those who remain for now.

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  • Spot on. Why the GP leaders and Patient Participation Group members understand and appreciate the issue behind the 10-min consultation.In 10 minutes you are just thinking of red-flags ruling out and let nature take care of rest of the stuff.

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  • Spot on. Why do not the GP leaders and Patient Participation Group members understand and appreciate the issue behind the 10-min consultation.In 10 minutes you are just thinking of red-flags ruling out and let nature take care of rest of the stuff.

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  • Well done. I couldn't have said it better.

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  • It is not the 10 minutes. You can take 15 or 20 or 30. But you cannot because you have to see 18 or 20 or more [ I have seen 18 emergencies!! extra] [ 42 one morning].
    It is the 1948 open ended John Wayne Contract.
    What is your solution?
    Since consultation rates per year rise inexorably [ 4 to 6 in NI from 2004 to 2015], we need to change the contract.
    We cannot blame the Govt or patients.
    The RCGP maybe for not defining safety.
    Almost all Royal colleges have defined safety.
    It is time we did.
    24 consults at 15 minutes or 20 at 20 or whatever.
    Unless we define safety, no point telling patients it is the Govt's fault or writing to MPs.
    It is up to us to stop whingeing and DO something about it.

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  • 15 minute appointments as standard, double appointments (30mins) positively encouraged - plenty of time to do a decent job, and most patients happy to contribute their co-payment - it's called Australia.....

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  • very well written.

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  • I rarely see anyone in 10 mins other than one problem being cough cold or uTI. rest 15 to 30

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