A few more minutes make a difference? The relationship between content and length of GP consultations

Abstract

Objectives: To investigate the relationship between the length of a medical consultation in a general practice setting and the biopsychosocial information obtained by the physician, and to explore the characteristics of young physicians obtaining comprehensive, especially psychosocial information.

Design: A prospective, longitudinal follow-up study.

Setting: Videotaped consultations with standardized patients on two occasions were scored for the amount of biopsychosocial information obtained. Consultation length was recorded in minutes. Subjects. Final-year (T-1) medical school students (n = 111) participated in the project. On completion of their internship one and a half years later (T-2), 62 attended a second time, as young physicians.

Main outcome measures: Content lists.

Results: Pearson's r correlations between content and length at T-1 and T-2 were 0.27 and 0.66, respectively (non-overlapping confidence intervals). Psychosocial content increased significantly when consultations exceeded 13 minutes (15 minutes scheduled). Physicians using more than 13 minutes had previously, as hospital interns, perceived more stress in the emergency room and had worked in local hospitals.

Conclusions: A strong association was found between consultation length and information, especially psychosocial information, obtained by the physicians at internship completion. This finding should be considered by faculty members and organizers of the internship period. Further research is needed to detect when, during the educational process, increased emphasis on communication skills training would be most beneficial for students/residents, and how the medical curriculum and internship period should be designed to optimize young physicians' use of time in consultations.

Figure 1.

Level (%) of the different content sub-indices by consultation length at internship completion. Notes: Psychosoc = psychosocial issues, Concern = the two cancer concern items, Invest = somatic issues. Short = consultation duration ≤ 10 minutes; medium = 11–13 minutes; long > 13 minutes. The F-value indicates difference in psychosocial content between the consultation-length groups.