GP Tutor Dr Michael Poplawski shares the tips he gives his trainee doctors – and more experienced GPs – for saving time in the consulting room
I’ve been told that I am fast at consulting. But I can also be very slow if required, sometimes spending more than 45 minutes with a complex and difficult patient where needed. Let’s be clear though. Being fast at consulting is not good and it’s not bad. But not having the choice to consult faster or slower is limiting, so let’s give you that option.
Here are some techniques you can adopt:
1. Get typing as soon as possible
Sit down, greet your patient, ask your opening question, listen to the initial presenting complaint, ask the second follow-up question and then get straight to typing. The golden minute is an amazing opportunity to let your patient open up with their story while you listen and start documenting.
I generally let the golden minute go on longer than one minute so that after two to three minutes and a few simple follow-up/red flag questions, the history has not only been taken, it’s already been documented.
One of my trainee doctors was always running late and during a supervised clinic it transpired that sometimes the typing up of notes after the consultation would take longer than the consultation itself. Breaking that habit really saved him time.
If you are worried about not maintaining eye contact with your patient because you are typing, you have two options. The first is not to document anything during the golden minute to give them your full attention and THEN get typing. The second is…
2. Learn to touch type
I have spoken a lot about touch typing and even made a video about my journey of learning how to touch type from scratch at the tender age of 38. I now consider myself a confident ‘touch-typist’ running at about 70-80 words per minute without needing to look at the keyboard. This not only allows me to not break eye contact while documenting, but, needless to say, is one of the most important ways to improve your speed.
3. Ask questions that will actually change management
We can get into the habit of asking questions that are important but don’t really make that much difference to the outcome of the consultation. I see this routinely among medical students. For example, a 50-year-old woman presents with a 1 cm, asymmetrical mole that has appeared in the past few months. It has three colours (blue, black, brown) with an irregular border and seems to be getting bigger. The management is a two week wait cancer referral. Medical students may ask the patient: Have you ever used sunbeds in the past?; Is there any family history of skin cancers?; Do you know if you had sunburn when you were a child?; Have you ever been exposed to certain chemicals like mineral oil or arsenic? If the patient answers no to any of those questions, the management is a two week wait cancer referral. If she answers yes to any of those questions, the management is a two week wait cancer referral.
4. REALLY know your guidelines
Occasionally, I witness what I call ‘meandering consultations’. The trainee or medical student asks lots of questions that relate to the presenting complaint’s system, they get the answers that satisfy the criteria for action, for example, IBS type abdominal pain or headaches and yet the questions continue, overlap, sometimes repeat and so on. At the end, I often ask the trainee what the management plan is only to discover that they still aren’t very sure.
That’s understandable when you are training and learning, but if you want to save time, invest in really knowing your guidelines. A great way to make sure you are on top of things is to attend an annual GP update course and then go through the course materials more thoroughly in your own time. Time spent doing this will save you time spent looking up guidelines in front of patients or after consultations.
5. Do referrals in front of your patient
I have sat in on a number of significant events analyses (SEAs) with regards to delayed diagnoses or missed referrals or x-ray or ultrasound requests. Sometimes, if we are running late, there is the temptation to make a note of the need to do a referral and then move on to your next patient and hopefully not forget at the end of your clinic.
That strategy probably works 99% of the time. But if you are a full-time GP and you see 14 patients per session for nine sessions a week (126 patient contacts a week), statistically speaking, you will likely miss one of those a week. And what if that was for a cancer referral?
Personally, I’ve found that dealing with referrals or investigations requests in front of a patient not only ensures that the task gets completed but can provide reassurance for the patient too since they get to see for themselves it’s been done. And I have had written feedback from patients saying they like it when I do it this way.
I simply say to them: ‘I’d like to keep you here while I do this referral in case I need to ask you anything more if that’s ok.’ I have never had a patient say they would prefer me to do the paperwork in my own personal admin time.
6. Take your essential breaks
If you need a toilet break, you need a toilet break. Walking up and down the stairs to the bathroom gives your eyes a rest from the screen and gets you out of your chair for a few minutes. Lunch breaks are also non-negotiable. People that know me know that I never miss lunch. Never.
Having said that once lunch was delayed by two hours when we had to rush out of the surgery to the neighbouring pub to help a man who had just collapsed. Still, after I got back, instead of jumping straight back into consultations, I had lunch first. When I apologised to the patients that had been waiting (who had already been informed by the receptionist about the incident in the pub), they were really understanding and the day actually ended up going quite well.
7. Use IT shortcuts
Regardless of which clinical system you are currently using, there are lots of tips and tricks you can use to speed things up. We use EMIS that has Quick Codes and Texts, which are keyboard shortcuts that allow you to write a lot using just a few taps on your keyboard. Combine that with templates and protocols and you shouldn’t be running an hour behind anymore. Well, barring the odd pub incident of course!