The content of general practice consultations: cross-sectional study based on video recordings

Soliciting additional concerns in the primary care consultation and the utility of a brief communication intervention to aid solicitation: A qualitative study

“…GPs considered eliciting ACs to be extremely important to ensure the identification of serious illness, to maximise efficiency, and to foster a positive patientdoctor relationship. These suggested benefits mirror those raised in previously published research [5,[14][15][16]. However, GPs also expressed apprehension over soliciting ACs, not only with regard to opening 'Pandora's box' [20,34] but also encouraging the expression of trivial (including self-limiting) concerns, thereby modifying future consultation behaviour.…”

“…This is particularly important since time restrictions may prevent the full management of multiple concerns [5]. Conversely, successfully soliciting ACs may facilitate early identification of serious problems, reduce patient anxiety, decrease the need for unnecessary intervention, and potentially increase patient satisfaction [14][15][16].…”

“…Demand for general practice in countries like the United Kingdom is increasing, with 40 million more consultations in 2014 than in 2008/09 [2]. Although patients typically attend GP appointments with multiple concerns [3][4][5], British GP consultations are time-limited; often scheduled to last for approximately 10 minutes [6]. In this time-restricted context, patients do not raise all of their concerns at the outset of their appointment, instead presenting their further concerns towards the consultation's close [4].…”

Access to primary care: creative solutions are needed

“…This is at odds with what we understand about our patients, who typically bring a number of interrelated problems into our surgeries. Salisbury and colleagues 10 showed that the average number of problems presented in a consultation is 2.5, with 41% of patients bringing >3 problems. This downward pressure on patients may ultimately be selfdefeating, and certainly flies in the face of the concepts of 'comprehensive' and 'personal' first contact medical care.…”

Can the outcome of primary care be measured by a Patient Reported Outcome Measure?

“…6 The comprehensive nature of care means that clinicians are often managing more than one problem or illness at a time, typically dealing with three problems or more per patient visit. 7 Additionally, many primary care interventions are preventative in nature; with no 'problem' to resolve. Thus the outcomes of primary care are very wideranging in nature and impact.…”