Management of Time in the Consultation

1. Management of Time in the Consultation Andrew Mowat

2. Introduction The 10-minute Consultation Putting the genie back in the bottle Transition from GPR to Principal

3. Overview Punctuality Controlling the Agenda Controlling the Time

4. Punctuality Start on Time Set limits on lateness Minimise interruptions

5. Controlling the Agenda Establishing ground rules notices, leaflets, education Looking for clues Defining the problem Opening Gambits Closing Gambits Exercise 1

6. Exercise 1: the long list Mrs Smith, a 75-yr-old arthritic widow, is a frequent visitor to your Surgery. She comes in today after something of a long interval for her, and says: �You�ve been so busy recently, I thought I�d save a few things up for you to deal with all at once�. Make it overt Set limits on today�s consultation Establish a time when the rest of her agenda will be dealt with Educate her in ways of making appointments for multiple problems

7. Controlling the Time Questioning open closed Body Language open closed Use of Resources Ending the Consultation Exercise 2

8. Resources Time allows problem to evolve allows patients/doctors thoughts to clarify Investigation Referral Self-Help groups

9. Exercise 2: the complex problem Mr White is a 40-yr-old Type 1 Diabetic. He has recently begun to feel excessively tired, has non-specific aches and pains, some sensory changes in his feet, and erectile dysfunction. Try and simplify the problem: bite-size chunks Use of Time investigations referral trial of intervention medication etc

10. Exercise 3: the late bombshell Miss Jones is a 16-yr-old new patient you are meeting for the first time. She has come to see you about her acne. After about 8 minutes of the consultation, she tells you she thinks she might be pregnant. Don�t despair: time isn�t everything! Deal with the important things today wanted or unwanted? evidence for suspicion etc Arrange review for the unimportant things: booking etc

11. Ending the Consultation (1) Verbal summarising arranging review Physical posture getting up opening door �the corridor consultation� paperwork prescription letter, form etc

12. Ending the Consultation (2) Last Resort walking out next patient asking for coffee telephone pager fire alarm

13. Summary Overview start on time control the agenda control the time use resources end the consultation don�t be afraid to run late

14. Aspirations The 15-minute consultation Pendleton�s Seven Tasks Patient responsibility choose appointment length? Private Healthcare