How to run to time as a GP

Probably my colleagues are laughing right now as they read that I’ve dared to write this article because I often run behind. But there have to be rescue strategies to make the best of the situation.   Perhaps this should be called more truthfully, “How to contain your surgery so that it doesn’t finish an hour and 45 minutes late leaving you with eyeliner on your cheek and a urine dipstick stuck to the back of your shirt.”

Anyway, here are a couple of tips to accelerate your way through a session:

Have plenty of kit as a locum

Some surgeries are super-organised and have everything stocked in the room. As for others…well, seeing the doctor must be more like a laying on of hands experience than a clinical examination.

The most useful kit goes beyond the obvious:  for some reason, staplers are like gold dust.  Ever noticed how the receptionists have branded each one with their name?

Sit up straight and face the patient

Sitting up makes it look like you’re listening but can also help contain conversational ramblers who think they’re on an afternoon outing.  Slouching backwards all relaxed in the chair invites patients to do the same and psychologically spread themselves out beyond the available.

Help patients get their cards on the table

Allow the patient to express their initial problem but then ask them if there is anything else; and anything else…until they run out of problems.  This gets the entire agenda on the table at the beginning, following which you can negotiate what is most important and manage time accordingly.

It can feel clumsy and isn’t always appropriate but saves surprises about back pain with incontinence after you’ve already endured 15 minutes of intense questioning about a verruca.

Ask patients to come back if there are too many problems to deal with

I was afraid of this for a long time but actually, many patients understand – as long as the practice isn’t in a state of drought when it comes to appointments.

Know what you’re doing

If you’re back from maternity leave, or do very few sessions then you’ll find that the train of medicine has steamed right ahead without you and you may have to accept an element of faffing around having to look things up.  Inevitably, this will slow you down.

Keeping up to date on common issues will help – or at least have something at your fingertips where you can find what you want.

This brings us on to….

Sound like you know what you’re doing

Yeah, we’re supposed to share uncertainty and all that.  Sometimes that’s ok but sometimes, if we’re waffling on and unsure, patients will pick up on this and ask more questions or want a referral or say, “But my gong therapist says….”.

Sounding confident will all help contain this stuff.  Dressing like a professional is also part of this.

See someone else why the patient is doing a urine sample

Even though modern life is a terrifyingly fast merry-go-round, let’s face it, many patients are on slow-speed and are just not under the same pressure of time-poverty as you.  Send a patient to the loo and they’ll be a queue, they can’t go or they say they need a glass of water in order to make them pee (why does this belief defy renal physiology?).

Ask patients to do their urine sample and then take a seat in the waiting room while you see someone else.

Don’t keep me hanging on the telephone...

On hold to the local hospital for half an hour trying to admit someone, all the while knowing that the person on the other end could submit you to a KGB style interrogation and refuse?  This is a huge drain on your time.

If secondary care are unobtainable, send the patient up with a letter including whom you bleeped and at what time and a polite comment that you presume they had an emergency on their hands.  2 unanswered bleeps is my personal cut-off threshold.

Signpost the way to the end of the consultation

Saying, “we need to wrap-up in a moment” helps prepare the patient for the end of the consultation as opposed to a clumsy verbal tussle to bring things to an abrupt end.

Signposting the way at the beginning can be useful, “we’ve got ten minutes,” informs the patient of where you’ve both got to get to in terms of time – people genuinely don’t realise.

What next?

Some doctors are great at running to time but the goal of being on time is just a mirage if there was never enough time in the first place.  Is it so bad to run behind?

Claire Davies, GP and Editor of the Network Locum (now Lantum) blog