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Time pressure reduces GPs’ adherence to guidelines

GPs are less likely to adhere to guidelines when conducting consultations under time pressure, say researchers who caution that the trend towards increased workloads and shortened consultations could risk patient safety.

The study

Each of 34 GPs working in primary care in the Thessaloniki metropolitan area of Greece were presented with four clinical scenarios involving patients with viral respiratory tract infections (RTIs). For each scenario, they were asked to respond to questions on a computer screen concerning medical history taking, clinical examination, referrals for laboratory tests, likelihood and certainty of the final diagnosis and treatment recommendations.

The GPs went through the first two clinical scenarios under control conditions with no time pressure, after which they did the third and fourth scenarios under time pressure, with reduced response times allowed for each question.

The findings

GPs asked significantly fewer questions concerning presenting symptoms, conducted less thorough clinical examinations and gave less advice on lifestyle as indicated by Greek national guidelines when they were working under time pressure then when under the control conditions.

Specifically, the GPs were less likely to ask about consciousness disorders during history taking under time pressure and less likely to examine the nervous system during the clinical examination to exclude the possibility of meningitis. They were also less likely to give smoking cessation advice when under time pressure than when working without time constraints.

Although they were no more likely to make an incorrect diagnosis, GPs felt less confident with their diagnosis while under time pressure.

What this means for GPs.

The researchers conclude that GPs’ adherence to guidelines concerning history taking and advice giving is compromised when working under time pressure. They conclude: ‘Given the tendency towards a reduction of consultation times across Europe, it is important to safeguard the accuracy and efficiency of the diagnostic and treatment process, in order to reduce medical errors and increase patient safety.’

BMJ Open 2013; 3: e002700