One of the challenges in training registrars is trying to get over the apparent emphasis on the speed of consultation, or what you might call – churn. For doctors in clinical and rooms there is a set amount of time and a certain number of patients. You could argue that there might be more patients than a reasonable amount of time and yes one could take the approach that one will take as long as necessary to o deal with all the patient issues but reality dictates that if you take that approach you probably won’t actually see al that many people and the population might be less-well served as a result.

Bosses can get grumpy with their registrars is they only see a few patients in their clinic and the clinic runs over time. Equally so the registrars might feel they are taking too long or perhaps not being thorough enough.

Rule 1 should be that every consultation isn’t a so-called long-case. I like to say…if there is nothing wrong then there is not much to say. Rule 2 should be that the focus is on effectiveness not efficiency. By this I mean – did you identify and sort out the problem? You can still this in a timely manner – you just need to adjust the pace to the circumstances. In my experience patients don’t like to be rushed but on the other hand they are more concerned with having their issues addressed and if you can do this the time it takes is of lesser importance. Flowing on from this then Rule 3 must be ‘deal with the most important concern to the patient’ – this is perhaps the hardest part. For starters what the doctor thinks is important and what the patient thinks is important isn’t always the same. Secondly what the patient thinks is important isn’t always transparent….this is the ‘there’s one more thing doc’ discussion.

So in summary – work out what’s important and deal with it and move on. This is effective and efficient consulting for a resource poor reality. In other words, until we get more resources to support whole person care and the time-unlimited consultation ‘Don’t sweat on the small stuff’