{"id":4714,"date":"2025-10-30T05:38:23","date_gmt":"2025-10-30T04:38:23","guid":{"rendered":"https:\/\/blogs.bmj.com\/medical-ethics\/?p=4714"},"modified":"2025-10-30T05:38:23","modified_gmt":"2025-10-30T04:38:23","slug":"one-problem-per-appointment-why-setting-limits-can-both-fairer-and-safer","status":"publish","type":"post","link":"https:\/\/blogs.bmj.com\/medical-ethics\/2025\/10\/30\/one-problem-per-appointment-why-setting-limits-can-both-fairer-and-safer\/","title":{"rendered":"\u201cOne problem per appointment?\u201d Why setting limits can both fairer and safer"},"content":{"rendered":"

By Dr. Richard Armitage<\/p>\n

As a GP, I rarely see a single-issue consultation. \u00a0One person comes with a sore throat, a bad back, and queries about their medications.\u00a0 Another comes with a headache, low mood, and wanting the results of a recent blood test.\u00a0 This is the nature of routine primary care.<\/p>\n

But it creates an ethical knot: with the clock ticking, do we try to do everything in one appointment \u2013 and risk thin, unsafe care \u2013 or, do we agree to do less now, but better, and address the rest later? \u00a0That question is what drove me to write the paper<\/a> recently published in the\u00a0Journal of Medical Ethics<\/em>. \u00a0Not because I wanted to police patients\u2019 lists, but because I wanted to think more carefully about what GPs owe to our patients, to the people in the waiting room, and to ourselves.<\/p>\n

Short appointments are the norm in most health systems, and consultation length varies dramatically across the world<\/a>; in many countries it remains very brief indeed.\u00a0 When time is scarce, attempting to address several\u00a0major\u00a0problems in one slot can make each decision shallower and riskier. \u00a0This is an ethical risk because rushing invites missed cues, poor safety-netting, and substantial errors that matter.<\/p>\n

Against that backdrop, my central claim is modest but (I think) important: a\u00a0transparent default\u00a0of \u201cone major problem per appointment,\u201d coupled with fast follow-up for anything left over, can respect autonomy, promote beneficence, avoid harm, and distribute scarce time more justly. \u00a0It isn\u2019t a rigid rule. \u00a0Patients and GPs should identify priorities together at the start; if issues are minor or tightly linked, we can safely bundle them; if two red flag problems present together, we obviously manage both. \u00a0But the ethical presumption should favour depth over breadth, because doing less \u2013 thoroughly \u2013 is often what protects people.<\/p>\n

The paper analyses this through four major ethical principles.\u00a0 Respecting autonomy<\/strong> doesn\u2019t mean \u201cthe GP must handle every problem right now,\u201d it means problems are handled in a way that is safe, explained clearly, and agreed with the patient, which may require follow-up.\u00a0 Beneficence<\/strong> doesn\u2019t mean \u201cdo everything,\u201d it means \u201cdo the most good you can well in the time you have,\u201d so GPs should prioritise the most clinically important and patient-important problem first.\u00a0 Trying to squeeze several major problems into one short slot increases the risk of harm (violating non-maleficence<\/strong>) through misdiagnosis, unsafe prescribing, and poor safety-netting, and also makes the GP run late in ways that can harm later patients.\u00a0 Justice<\/strong> doesn\u2019t mean everyone getting exactly one appointment; it means fair access based on need and complexity, which means some patients appropriately need more than one appointment. \u00a0The paper also notes that routinely forcing GPs to manage multiple complex problems in one slot fuels burnout, which threatens patient safety and contributes to GPs leaving the workforce, further reducing access for everyone.<\/p>\n

Primary care will always be messy. Our ethical commitments should help us navigate that mess without pretending it isn\u2019t there.<\/p>\n

Article: On multiple problems: the ethics of multiple problems in single general practitioner appointments<\/a><\/strong><\/p>\n

Author: <\/strong>Dr. Richard Armitage<\/p>\n

Affiliation: <\/strong>University of Nottingham<\/p>\n

Conflicts of Interest<\/strong>: None<\/p>\n

Social media: <\/strong>@drricharmitage<\/p>\n

 <\/p>\n","protected":false},"excerpt":{"rendered":"

By Dr. Richard Armitage As a GP, I rarely see a single-issue consultation. \u00a0One person comes with a sore throat, a bad back, and queries about their medications.\u00a0 Another comes with a headache, low mood, and wanting the results of a recent blood test.\u00a0 This is the nature of routine primary care. But it creates […]<\/p>\n

Read More…<\/a><\/p>\n","protected":false},"author":522,"featured_media":0,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[1081,8057],"tags":[],"class_list":["post-4714","post","type-post","status-publish","format-standard","hentry","category-consultation","category-medical-ethics"],"yoast_head":"\n\u201cOne problem per appointment?\u201d Why setting limits can both fairer and safer - Journal of Medical Ethics blog<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/blogs.bmj.com\/medical-ethics\/2025\/10\/30\/one-problem-per-appointment-why-setting-limits-can-both-fairer-and-safer\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"\u201cOne problem per appointment?\u201d Why setting limits can both fairer and safer - Journal of Medical Ethics blog\" \/>\n<meta property=\"og:description\" content=\"By Dr. Richard Armitage As a GP, I rarely see a single-issue consultation. \u00a0One person comes with a sore throat, a bad back, and queries about their medications.\u00a0 Another comes with a headache, low mood, and wanting the results of a recent blood test.\u00a0 This is the nature of routine primary care. 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