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By Michael Sheldon, John Brooke, Alan Rector

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The Consultation Process constructed by our medical schools. In doing so, we have become more efficient, but at the considerable cost of becoming more officious. We have only to look at the work of Cartwright (Cartwright 1967; Cartwright &: Anderson, 1981) to see that, despite many changes in general practice, the image we show to our patients is no better and often actually worse. " That is no longer enough, for that question implied that the symptom had to be presented to uso Such presentation depended on there being a symptom in the first place, on it worrying or bothering the patient and on a whole series of attitudes within the patient, wh ich influenced his decision to consult the doctor in order to have his symptom evaluated.

Patients complain of rushed, hurried doctors and this becomes more apparent in my patient satisfaction survey when appointment times are very short. Appointment times could, of course, be too long - we all know how a long interview can be emotionally draining. It may be that there is a maximum time governed by doctor effieiency, just as there may be a minimum time constrained by patient efficiency in communicating his problem. % IIme pent CONSULTING 20 115 10 CAN Al o IS 01( S us NI. f) UK Figure 8 Percentage of time spent consulting in 11 different countries (legend as for Figure 7) This led us to develop a video-taped examination in wh ich students saw a case develop, in fourteen very short sequences, answering a quest ion paper after each sequence.

17 16 % lwne Spenl VISlTlN0 16 13 12 11 10 9 8 7 I. 3 ? o o Nl A UK DK 15 CAN AI. Figure 7 Percentage of time spent visiting in 11 countries A = Austria AL = Australia B = Belgium CAN = Canada D = West Germany DK = Denmark IS = Israel NL = Holland S = Sweden UK = Uni ted Kingdom US = United States US 'I 24 Decision-making in General Practice But it is in consulting that the difference is most relevant to my theme (Figure 8). British doctors actually spend less time consulting than do other doctors and only about half the time that their Canadian counterparts spend seeing patients in the surgery or office.

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