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Ten minutes and counting

Copperfield

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I’m not generally known for my patient-centredness. That said, I’m less draconian than many of you about the one-problem-per-consultation ‘rule’.

I just think it’s unfair, unrealistic and harder to justify now that patients have to wait weeks for an appointment and therefore inevitably develop, say, a vibrating feeling or itchy nipples between booking and being seen.

Besides, if a patient has a list consisting of malaise, blurred vision, dry mouth, recurrent thrush and erectile dysfunction, that’s potentially five appointments before their diabetes gets diagnosed.

I do have my limits, though, as ably demonstrated by a patient I saw today. We galloped through a fungal nail infection, olecranon bursitis, the pros and cons of PSA testing and a cough, and I was feeling pretty slick and self-satisfied. Then, at precisely nine minutes and 59 seconds, he uttered one of the most deflating sentences I’ve ever heard in a consultation. Specifically, ‘Anyway, that’s not why I came, what I really want to know is why do I feel tired all the time?’

The way ahead is to ram home the ‘Ten minutes per consultation’, rather than the ‘One problem per consultation’ message

In the one second remaining, I considered my options and came up with what I thought was the perfect answer: ‘I don’t know.’ This led to the following exchange:

‘What do you mean, you don’t know?’

‘I mean, I don’t know what’s making you tired.’

‘Well, couldn’t you make some effort to find out?’

‘Absolutely, so if you’d like to book an appointment…’

‘I have booked an appointment. This one.’

‘But this one is over.’

‘No it isn’t, we haven’t sorted out my tiredness.’

‘Look, let me explain. If you went into the ‘Pizza for ten quid’ shop, and spent your tenner on a deep pan pepperoni, and when they brought it to you, you said that, actually, that’s not what you came in for, actually you wanted a margherita with extra mushroom, I think they’d be justified in charging you another tenner. Yeah?’

‘But I don’t like pizza.’

‘Look, just sod off, will you?’

Clearly, the way ahead is to ram home the ‘Ten minutes per consultation’, rather than the ‘One problem per consultation’ message. That’s why, on the wall behind my head, right in the patient’s line-of-sight, I’m going to set up a huge digital stop-clock which I will re-set to ten minutes at the beginning of each consultation. It will tell the patient, ‘You have X minutes and Y seconds of your consultation left’. When it reaches zero, it will start flashing the message, ‘You are entering one minute of injury time’.

And if they say, ha, I didn’t come with an injury, I’ll say, no, but you might leave with one.

Dr Tony Copperfield is a GP in Essex. You can follow him on Twitter @DocCopperfield

 

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Readers' comments (12)

  • Fantastic!

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  • Lol

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  • David Banner

    I used to set the timer on my phone to count down 10 minutes, ending with the irritating sound of a duck, then proclaim "the quack says it's time to go". Went down like a fat kid on a seesaw...........

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  • Fabulous

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  • Dear Dr Copperfield,
    I politely request permission to use your insights when responding to customer aggrievances i.e. 'Dear Complaints Manager, following profound reflection and with deep remorse yadda, yadda.............but it was in injury-time'.

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  • The ones I like best are the ones who tell you they've just come about a sprained eyelash or a curly toenail, so you take the opportunity to babble on about health promotion and ideas, concerns and expectations and all that stuff we used to have time to do, and then, at nine minutes and fifty-nine seconds, they say, "Oh, by the way, is it normal to start to get crushing pain in my chest when I walk?" or, "Oh, and, I promised my daughter I'd mention the lump in my breast, but I don't think it'll be anything, do you?"

    I don't normally enforce "one symptom per appointment" and haven't noticed that I get through my surgeries any more slowly than colleagues who do.

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  • During one of my many existential crises and in particular around time keeping, I invested in one of those clocks where the hands go backwards and the numerals are in reverse order. This was placed carefully behind me for the patients benefit.

    If ever the patients referred to it during the course of their consultation I realised their symptoms were less important to them than a clock that went backwards, and therefore I invested a similar amount of effort.

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  • 4 cheeses

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  • OK JJ - I'll raise you one - 'Margarita'

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  • I have commissioned a very large and expensive 10 minute sand timer to be produced for this purpose exactly

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