Investigating the relationship between consultation length and patient experience: a cross-sectional study in primary care

Natasha Elmore; Jenni Burt; Gary Abel; Frances A Maratos; Jane Montague; John Campbell; Martin Roland

doi:10.3399/bjgp16X687733

Published eLetters

eLetter submission guidelines

Submit a Response to This Article

Compose eLetter

Title *

Author Information

Contributors

First Name and Middle Initial *

First or given name, e.g. 'Peter'.

Last Name *

Your last, or family, name, e.g. 'MacMoody'.

Email Address *

Your email address, e.g. higgs-boson{at}gmail.com. PLEASE NOTE: your email address will be published.

Occupation *

Your role and/or occupation, e.g. 'Orthopedic Surgeon'.

Affiliation *

Your organization or institution (if applicable), e.g. 'Royal Free Hospital'.

Statement of Competing Interests

Competing interests? *

Yes

Please describe the competing interests

CAPTCHA

This question is for testing whether or not you are a human visitor and to prevent automated spam submissions.

Vertical Tabs

Jump to comment:

Giving patients choice of appointment length
Rod Sampson

Published on: 24 February 2017
Consultation length - author response to Dr Brigid Joughin
Natasha Elmore and Jenni Burt

Published on: 23 January 2017
Consultation length - author response to Dr Brian Goss
Natasha Elmore and Jenni Burt

Published on: 23 January 2017
Consultation length
Denis Pereira Gray and Peter Orton

Published on: 16 January 2017
Consultation length
Brian Goss

Published on: 02 January 2017
Consultation length
Brigid Joughin

Published on: 08 December 2016

Published on: (24 February 2017)
Page navigation anchor for Giving patients choice of appointment length
Giving patients choice of appointment length
Rod Sampson, GP, Cairn Medical Practice, Inverness
I appreciated Natasha Elmore's thoughtful and considered responses to correspondence linked to her recent publication. We previously carried out work on giving patients the choice of appointments length,¹ and found (contrary to GPs expectation) that patients were accurate at estimating appointment length required. Having chosen a specific appointment length, patients also gave careful thought as to how they may manage their own consultation, based on consult duration preference.

Reference

1. Sampson R, O’Rourke J, Hendry R, et al. Sharing control of appointment length with patients in general practice: a qualitative study. Br J Gen Pract 2013 doi:10.3399/bjgp 13X664234.

Competing Interests: None declared.
Published on: (23 January 2017)
Page navigation anchor for Consultation length - author response to Dr Brigid Joughin
Consultation length - author response to Dr Brigid Joughin
Natasha Elmore, Research Associate, Health Services Research, University of Cambridge
Other Contributors:
Jenni Burt, Senior Research Associate, Health Services Research, University of Cambridge
Thank you for your response. We were also surprised at the lack of correlation between consultation and patient experience and patient satisfaction. In reference to your first point, the national GP-Patient survey questionnaire communication items which we used in the study ask the patient specifically about whether they feel they had enough time in the consultation. We conducted separate analyses to investigate whether there was any relationship between this item and consultation length and found no evidence of an effect. There has been some interesting work conducted about patient perceptions of time in general practice by Ogden et al.¹ She found that overall, patients tended to underestimate the time spent with their doctor. She also measured preferred time post-consultation and found that patients would have preferred longer with their GP. We agree it would be interesting to study patients’ estimations of how much time they think they will need before the consultation.

With regards to your second point, we suspect you are correct in your hypothesis that there may be a stronger correlation. Unfortunately this is not something we measured as part of this study, although we did ask GPs to complete the same communication scale as patients and compared ratings of GPs and patients in the same consultation. We will be reporting these findings in a separate paper: essentially we found that GPs tended to be more self-cr...
Show More

Thank you for your response. We were also surprised at the lack of correlation between consultation and patient experience and patient satisfaction. In reference to your first point, the national GP-Patient survey questionnaire communication items which we used in the study ask the patient specifically about whether they feel they had enough time in the consultation. We conducted separate analyses to investigate whether there was any relationship between this item and consultation length and found no evidence of an effect. There has been some interesting work conducted about patient perceptions of time in general practice by Ogden et al.¹ She found that overall, patients tended to underestimate the time spent with their doctor. She also measured preferred time post-consultation and found that patients would have preferred longer with their GP. We agree it would be interesting to study patients’ estimations of how much time they think they will need before the consultation.

With regards to your second point, we suspect you are correct in your hypothesis that there may be a stronger correlation. Unfortunately this is not something we measured as part of this study, although we did ask GPs to complete the same communication scale as patients and compared ratings of GPs and patients in the same consultation. We will be reporting these findings in a separate paper: essentially we found that GPs tended to be more self-critical, compared with patients, which may give an indication of the direction of the hypothesis you suggest.

Reference

1. Ogden J, Bavalia K, Bull M, et al . “I want more time with my doctor”: a quantitative study of time and the consultation. Fam Pract 1;21(5):479-83.

Show Less

Competing Interests: None declared.
Published on: (23 January 2017)
Page navigation anchor for Consultation length - author response to Dr Brian Goss
Consultation length - author response to Dr Brian Goss
Natasha Elmore, Research Associate, Health Services Research, University of Cambridge
Other Contributors:
Jenni Burt, Senior Research Associate, Health Services Research, University of Cambridge
Thank you for your response. Consultation length was as you suggest, observed rather than imposed. We were careful not to imply causality: as you rightly suggest, we cannot do so from observational data alone. We concluded that we found no correlational relationship between length of consultation and patient experience or patient satisfaction.^1,2

In our closing remarks in the full paper, we suggest that,

‘Some consultations may be appropriately short, with both doctor’s and patient’s agenda effectively addressed, for example, where the doctor is dealing with a simple administrative issue or following up a problem with a patient whom they know well.”

This appears to be the conclusion you have also come to in your letter. We note in the full paper that a lack of evidence of an effect is not necessarily a lack of effect, and we do not want to suggest that consultation length should be made shorter or is not important for other areas of clinical practice.

References
1. Ahmed F, Burt J, Roland M. Measuring patient experience: concepts and methods. Patient 2014 1;7(3):235-41.
2. Price RA, Elliott MN, Zaslavsky AM, et al. Examining the role of patient experience surveys in measuring health care quality. Med Care Res Rev 2014; 1;71(5):522-54.

Competing Interests: None declared.
Published on: (16 January 2017)
Page navigation anchor for Consultation length
Consultation length
Denis Pereira Gray, Consultant, St Leonard’s Research Practice, Exeter
Other Contributors:
Peter Orton, Managing Director, Research Unit, Aviation Medica, London Stansted Airport, Essex
Consultation length in general practice has long been seriously under researched given its central importance, so it is interesting that two articles on it should appear in the month of October. That two professors of general practice in Exeter draw opposite conclusions adds to the fun!

The key issue is serious as Orton et al.¹ show that longer consultations are significantly more patient-centred and beneficial for patients whereas Elmore et al.² find no benefit in terms of patient experience from longer consultations.

Both studies have the advantage of studying substantial numbers of precisely-timed consultations 440 in Elmore et al. and 842 in Orton et al. The latter applied an internationally-validated instrument for assessing patient-centeredness, whereas Elmore et al. had the advantage of obtaining patient responses directly.

A weakness in both studies is that they had relatively few consultations lasting 15 minutes or more; only 74, (16.8%) in Elmore et al and 50 (6.1%) in Orton et al. Benefit for patients is likely to be optimised when patients know that they will receive at least 15 minutes and then on average do so, which applied in neither study.

Elmore et al. studied practices “below the 25th percentile for mean communication score in the 2009– 2010 su...
Show More

Consultation length in general practice has long been seriously under researched given its central importance, so it is interesting that two articles on it should appear in the month of October. That two professors of general practice in Exeter draw opposite conclusions adds to the fun!

The key issue is serious as Orton et al.¹ show that longer consultations are significantly more patient-centred and beneficial for patients whereas Elmore et al.² find no benefit in terms of patient experience from longer consultations.

Both studies have the advantage of studying substantial numbers of precisely-timed consultations 440 in Elmore et al. and 842 in Orton et al. The latter applied an internationally-validated instrument for assessing patient-centeredness, whereas Elmore et al. had the advantage of obtaining patient responses directly.

A weakness in both studies is that they had relatively few consultations lasting 15 minutes or more; only 74, (16.8%) in Elmore et al and 50 (6.1%) in Orton et al. Benefit for patients is likely to be optimised when patients know that they will receive at least 15 minutes and then on average do so, which applied in neither study.

Elmore et al. studied practices “below the 25th percentile for mean communication score in the 2009– 2010 survey, adjusted for patient case mix.” This group selected for relatively poor communicators probably lacked the consulting skills to give patients a good experience, even with more time. This important limitation was clearly stated in the full version, but did not appear in the two page printed summary.

We do not believe that results from GPs selected on the grounds of being poor communicators can be generalised. An absence of evidence does not indicate evidence of absence.

Meanwhile, decisions must be taken by managing partners about how long on average patients’ appointments should be. We confirm that in our two very different research general practices patients receive on average 15 minutes or more (mean 16.1 minutes in St Leonard’s).

Further research on consultation length is urgently needed.

References
1. Orton P, Pereira Gray D. Factors affecting consultation length in general/family practice Fam Pract 2016; 33 (5): 529-34.
2. Elmore N, Burt J, Abel G, Roland M, Campbell JL. Investigating the relationship between consultation length and patient experience: a cross-sectional study in primary care. Br J Gen Pract 2016; 66(653):e896-e903.

Show Less

Competing Interests: None declared.
Published on: (2 January 2017)
Page navigation anchor for Consultation length
Consultation length
Brian Goss, Freelance GP
Am I right in thinking that consultation length was 'as observed' rather than imposed on the consultations? If so, surely this study does not support the conclusion that consultation length does not affect satisfaction? In order to test that hypothesis surely one would have to either impose consultations lengths randomly regardless of the problem presented or stratify the observed consultations for a measure of complexity. Otherwise all you have demonstrated is that the GPs varied consultation length in order to deliver a certain level of satisfaction. This is still a useful conclusion, but not the one you assert.

I would be interested to know if I have grasped the wrong end of the stick here.

Competing Interests: None declared.
Published on: (8 December 2016)
Page navigation anchor for Consultation length
Consultation length
Brigid Joughin, GP partner,, Newcastle University
I read with interest this article and note the poor correlation between consultation length and patient satisfaction. This does somewhat surprise me, though I can see for some patients a quick consult which satisfies their immediate simple need could be satisfactory. It would be interesting to study patients perception of actual length of appointment compared to length they thought they would need.

I would also be very interested to know how consultation length relates to GP work satisfaction ratings....I suspect a better correlation there!

Competing Interests: None declared.

Main menu

User menu

Search

Investigating the relationship between consultation length and patient experience: a cross-sectional study in primary care

Published eLetters

Plain text

Vertical Tabs

Jump to comment:

In this issue

Citation Manager Formats

Keywords

More in this TOC Section

Related Articles

Cited By...

NAVIGATE

RCGP

MY ACCOUNT

NEWS AND UPDATES

AUTHORS & REVIEWERS

CUSTOMER SERVICES

CONTRIBUTE

CONTACT US

Main menu

User menu

Search

Investigating the relationship between consultation length and patient experience: a cross-sectional study in primary care

Published eLetters

Plain text

Vertical Tabs

Jump to comment:

In this issue

Citation Manager Formats

Jump to section

Keywords

More in this TOC Section

Related Articles

Cited By...

NAVIGATE

RCGP

MY ACCOUNT

NEWS AND UPDATES

AUTHORS & REVIEWERS

CUSTOMER SERVICES

CONTRIBUTE

CONTACT US