Isabella Laws: Are GP consultations becoming tick-box exercises?

isabella_lawsEverything we learn at medical school hones our ability to effectively conduct a consultation within 10 minutes. We are taught first to examine the body’s systems fully and methodically, then we learn how to focus them in order to save time. We are instructed to ask open questions and invite the patient to speak, then to direct them in order to rule out differential diagnoses. We are even assessed in this way; by the time you sit your finals all OSCE stations are either 10 or 15 minutes long.

For a student, trying to do all this in the allotted time is endlessly overwhelming. This is not only because you are trying to reach a diagnosis within the 10 minutes, but also because you are interacting with another human being. This interaction is something that can’t be faked; a connection, and I think it’s always painfully obvious to both parties when it isn’t achieved. At medical school they dress this human connection up as “ICE”: ideas, concerns, and expectations. They tell us: find out what the patient wants, find out what they’re worried about. Well, who of us has ever opened up to someone we didn’t think was empathetic? Despite having some medical knowledge and the experience of talking to patients, I myself have been reluctant to open up to doctors I didn’t really click with.

Time is the most important factor in achieving consultations that are effective clinically yet remain human. Sitting in on GP consultations, I have seen again and again when GPs are forced to hurry through the human side of the consultation because they are short on time. Part of the reason for this, I think, is that an increasing amount of the consultation is filled with “must-ask” topics. You must always ask about smoking (and if they do smoke, ask them if they’re interested in quitting), drinking (remember to quantify how much), enquire if they’d like a diabetes check, check blood pressure (offer advice on salt intake), and offer appropriate vaccinations. Recently The Lancet published a study that said that a 30 second conversation between doctors and patients can trigger significant weight loss. Is this going to become another “must-ask” topic? And when on earth are you meant to fit all this in? I understand that asking about these topics has worth, but it worries me that the workplace I have yet to enter values meeting targets from asking these rote questions above talking to patients.

Patients often present to GPs with multiple problems, and regularly leave the one they’re most worried about until last. Every patient is different, and requires a different approach—something you can’t achieve if you’ve got a list of questions you have to get through.

Of course, I acknowledge that there are GPs who probably do all this effectively and manage to do it without sounding like a robot, but in my experience they are in the minority. I think it’s important to consider the average doctor seeing a patient at the end of a long day. Will they be able to manage it? If doctors are meant to ask about all these topics and continue connecting with patients, then something has to change.

Isabella Laws is a 5th year medical student who is currently intercalating in Medical Journalism.

Competing interests: None declared.