Journalists are attacking us again. A Torygraph article reported a recent study – in a Shock! Horror! Probe! headline kind of way – that some GP consultations can take as little as two minutes. For 15 years, until September, I was a Principal in general practice in Cambridge where the allotted time for a pre-booked appointment was 10 minutes, and five for booked-on-the day emergencies. This seemed to work well, as long as patients understood that there wasn’t time for multiple problems nor for long discussions on the pros and cons of new diets, vitamins and…….
If someone attended with something that was easy to diagnose with a glance down the throat (tonsillitis) or a temperature check and a ‘sounding’ of the lungs with a stethoscope (chest infection), then a providing an antibiotic prescription plus a sound bite of health education might indeed take just a couple of minutes. This would then mean that more complex problems could take longer. Whatever the system, there is always the option of booking double (20 minute) appointments and also offering a follow up a consultation a week or 10 days later, and another and another. Many people judge that such an appointment system isn’t giving patients enough time but in my experience, many people in crisis find the offer of regular appointments for a while comforting and it can help them get through the worst of it.  And with this system I believe I grew to know well those within the 2500 patients registered with me who had recurrent or persisting problems.
When I was new to general practice I would allow patients in crisis to have long, long appointments – sometimes people would stay weeping for up to 40 minutes. Usually they’d start repeating their story after less than 10 minutes – for emphasis, no doubt, perhaps unaware how carefully I’d been listening. Meanwhile I’d be thinking that by now my waiting room must be heaving with impatient patients and I’d be hoping for the rest of my consultations to be straightforward - for skin infection or cystitis, for example.
I learned to interrupt gently and tell patients to come back at the end of my surgery or later in the week. Sometimes, patients recovered amazingly quickly if just offered a few sleeping pills to allow them to draw breath and get some catch-up sleep. I’d also promise to be there for them while worrying that by offering unlimited repeat appointments I might make patients unhealthily doctor-dependent. Almost always though, long before I’ve even starting to think this patient is coming too often he/she would have started sleeping again and had begun to see some chinks of hope and they’d stopped booking to see me. With committed GPs this system works well.
One challenge is to get patients to trust us again. Sometimes I play a game with myself, wondering if I could guess the diagnosis between calling my patient from the waiting area and walking with them into my consulting room. There is a lot to be learned in the way people walk or limp, whether they look like the weight of the world is on their shoulders, whether the cough is the special waiting room tickle put on for the doctor or the hacking body-wracking cough of pneumonia, whether there is the give-away smell of cigarettes or alcohol or ketones on the breath, whether the hair is lank, whether the skin colour is good – or too good (booze or hypertension) – or pale, whether there is sweating, suggesting really bad pain, fever or a someone being about to vomit or faint. An experienced GP sees a lot, knows a lot and can do a lot for her patients.
The challenge is to get the government off our backs – and journalists to realise we are doing our best – so we continue to have the time, energy and enthusiasm to do our work rather that get bogged down with pointless bureaucratic tasks, meetings and paperwork. It is this that is driving a lot of us out of general practice. That is one of the main factors that drove me to leave.