a routine consultation – you are asked for a repeat prescription, you check their
BP and then diagnose some paraesthesia in their hand as early carpal tunnel
syndrome…. and just as you are about to terminate the consultation, you get hit
between the eyes with: ‘My partner has just lost his job and talked about
ending it all last night’ or ‘My son has just announced that he wants to change
throw-away line at the end of the consultation can seldom be ignored. The
patient may save their last minute concern out of embarrassment or a reluctance
to raise the topic. You then have to deal with it there and then, and come up
with some solution until another appointment can be arranged.
Set expectations at the time of booking
Good communication in the
reception area and in your consulting room can mitigate situations like this by
managing your patient’s expectations effectively and ultimately, saving time.
Ensure practice staff are trained about patient expectations. When
a patient phones for an appointment, the receptionist should advise the patient
of the standard consultation timeframe and how many issues can be covered in
that time – one or two issues. If the
patient has multiple issues, the receptionist can suggest that the patient book
a long consultation.
If you have an online booking system, it could require the patient
to nominate the number of issues that need to be dealt with during the
consultation and then allocate a long consultation if there are multiple
It’s a good idea to check with the
patient early on in the consultation about their agenda to determine what their
expectations are as to what will be covered during the consultation. Listen
carefully to why they are seeing you and clarify any unrealistic expectations
as to what can be covered in the time available.
way to avoid the ‘end-of-consult sabotage’ is to encourage your patients to
write a list of all the issues they want sorted out. This will allow you to
prioritise the items on the list. The patient can help you decide the order of
importance for each item and you can start working from the top and systematically
cover as many items as time will permit. If you don’t get through all the items,
then the patient can arrange another appointment.
our article ‘Managing patients who present with multiple issues in a standard
consultation’ and download our posters to remind
patients of their obligations when booking an appointment.
our eLearning course ‘Effective communication’ or read our
unrealistic patient expectations’.
Share your view
We welcome your feedback on this article – email the Editor at: firstname.lastname@example.org