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Do You Resent Having to Wait, But Also Resent Being Dismissed Too Quickly By Your Doctor
If you get annoyed and want your doctor to hurry up and stop talking so much so that you can get in there, but get just as annoyed when he or she dismisses you too quickly, have you ever reflected on the fact that you are being a bit unreasonable? Isn't it somewhat selfish to consider that your problem is more important, and requires more consideration than the patient ahead of you as well as the one after you? If the walls are thin between the waiting room and the consultation room, sometimes patients stuck outside may complain to the receptionist that the doctor is discussing golf or some other non-relevant topic with the patient inside. Is this doctor going too far in establishing a meaning relationship with a patient, or is it a way to encourage open dialogue between the doctor and the patient?
 Apparently, many things will determine the length of time for consultations, and so Deveugle et al decided to examine the question by means of a multilevel analysis. Three levels were included: Country, general practitioner, and patient. They based their study on a larger Eurocommunication study and published the results in the August 31, 2002 issue of BMJ under the title "Consultation length in general practice: cross sectional study in six European countries." The idea was to see how different factors play a roll in determining how long consultations will be. It turned out that the doctor, the doctor's country, and the patient all demonstrated variables important in deciding how long a consultation will last. Sex difference also played a role since women seen in urban practices who were felt to have psychological problems, as might be expected, ended up in longer consultations.
The levels involved for general practitioners as individuals compared to their country of origin, were pretty equivalent. The former had a total variance in consultation length of 23%, the latter 22%. The variables for patients ran much higher at 55% of the variance. Taken together, the sum of the two doctors' variances was about the same as for that of the patients. For both sexes, psychological factors tended to add to length of consultation, but women with such problems tended to be allowed more time. Although women with psychological factors in urban practices got longer consultations, both rural and urban patients with these factors were in the office much longer than others. Obviously the more problems involved, the longer the time element, and as might be expected, older patients get more time. Again the obvious comes to the fore when it was noted that a greater workload for the doctor means less time for each patient. On the other hand, perhaps unexpectedly, sex or age of the doctor played no role, nor did the patient's level of education.
This study was run in six European countries. Although that represents a lot of countries, it still is not representative of other regions such as Asia, the Americas, the Middle East, etc. There are many other variables that come into play, as well as questionable characteristics of the physicians and regions chosen for study. Here are some other pointers of interest:
1. This study found that a doctor's sex and age did not play a role in determining length of a consultation. This contrasts markedly with the introduction to the article which states that "The characteristics of doctors that have the most effect on consultation length are doctors' age, sex, and attitude and the size of the doctor's list of patients" as noted in a review published by Wilson back in 1991.
2. Most patients seem to be satisfied with the time spent on them, but many feel that they need more time, and better use of the time actually spent according to Wilson.
3. Doctors with positive attitudes towards mental health problems usually spend more time.
4. The number of patients only seems to play a role if the list is either very long or very short.
5. Buchnan and Richardson writing in 1978 found that age and social class are important determinants.
6. Obviously doctors spend more time on new problems than those already discussed.
7. Interestingly one study found that doctors tend to prescribe less during long consultations.
8. Determining the exact length of a consultation is often difficult, and different researchers tend to use different approaches. This makes for inaccuracy when comparing studies - a bit like comparing apples and oranges. In this study all consultations were videotaped.
Not all patients are satisfied with long consultations. Some feel that a doctor should have the answers on the "tip of the tongue." Anything else means that he or she is just fishing for the answers. Which category do you fit into? Do you feel that a physician, who is abrupt, comes to fast conclusions, and dismisses you quickly is more likely to be well versed in the subject and doesn't need much time or effort to reach a decision? On the other hand, perhaps you feel that such behavior is common among authorities in all fields of endeavor when knowledge of the subject is limited, and it's easier to act knowledgeable if you can get out from under as fast as possible without betraying your ignorance? Then again, what about the simple element of compassion? Wouldn't a compassionate doctor tend to spend more time with patients than someone who's just "looking for a fast buck?"
Didn't have to wait for Doctor Hyne,
One minute in, five minutes out,
Just take this pill and you'll be fine,
Six months later, still had gout.
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Tried again with Doctor Klop,
One hour in, one hour out,
Talked about my mom and pop,
Six months later, still had gout.
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Who is better, there's little doubt
Obviously no need to bicker,
Why waste time, and still have gout.
Go see Hyne, and get done quicker.
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Cartoons and Poems following each article are created and copyrighted by Dr. Ackerman and cannot be copied or reproduced without his permission.
Copyright © 2006 by Marvin Ackerman, M.D.
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