No, it’s not the latest Tik Tok challenge. It’s just your average day for a GP.
New data from Monash University has shown that GPs tackle, on average, eight health issues in a 19-minute consultation.
Those numbers won’t come as a surprise to TMR readers, but it’s clear the authors of a study using a new tool to describe a day in the life of a GP think it’s not well known enough among health decision makers, and it really needs to be.
And they want those policymakers to know that it’s not just eight health issues in 19 minutes every now and again.
“The complexity of a single consultation should be considered in the context of a possible 144 consultations per week per full-time GP,” they wrote in the Australian Journal of General Practice.
“This study work offers further insights on the intense cognitive load that GPs and medical students experience as part of this vocation.
“It is unsurprising then that the Australian primary healthcare sector is experiencing the dual crisis of high GP burnout and low medical student recruitment.
“We, and others, anticipate widespread future workforce issues if no substantive action is taken by policymakers to address these concerns.”
While the findings might be familiar to GPs, the data source for the research might be less well known – the National Centre for Healthy Ageing’s new simulation facility, the Digital Library for healthcare interactions.
The Digital Library is a video library of interactions with older people, including GP consultations.
Its focus is on understanding and improving communication between patients and health practitioners. As well as for research, it can be used for training.
The National Centre for Healthy Ageing is a research centre established by Monash University in Melbourne and Peninsula Health, a public healthcare provider for Frankston and Mornington Peninsula in Victoria.
The centre has simulation facilities where researchers can test out ideas and develop and evaluate new models of care, and the Digital Library is one of those simulation facilities.
“This infrastructure is essential as healthcare consultations are often described as ‘black boxes’ occurring behind closed doors, often meaning we know little about successful engagement strategies between the clinician and the healthcare consumer,” the NCHA website says.
Miscommunication failures lead to medical errors. And while not all are due to miscommunication, the NCHA says medical errors lead to over 18,000 deaths in Australia every year.
“There are many and varied clinical situations where communication failures can occur including poor handover between clinicians about a patient’s condition, inadequate consent processes, and poor rapport or bedside manner.
“A taxonomy of communication failures in the UK highlighted more than 50 categories of communication error,” they wrote.
“Recordings from real-life consultations provide valuable data for communication research and education. Additionally, recordings from simulation-based education of health care students can provide valuable data for health care education research,” says the protocol for the repository of recordings.
Related
This study used 54 recordings of GP consultations from four different doctors in Melbourne between August 2021 and June 2024 (most during covid lockdowns), along with patient pre- and post-consultation surveys and patient demographic data.
The average consultation length was 19 minutes, during which a mean number of five ICPC-2-coded items were discussed and another three mentioned.
“The complexity of a single consultation should be considered in the context of a possible 144 consultations per week per full-time GP,” the authors wrote.
Issues raised during consultations included musculoskeletal (in 56% of consultations), cardiovascular (56%), psychological (30%), respiratory (24%) skin (22%), digestive (20%), Female genital system (19%) and neurological (17%) complaints, and nutrition and weight management counselling (50%). Nearly all consultations required knowledge of medications (98%).
Eight out of 10 involved an administrative burden, including creating pathology and imaging requests, medical certificates, calling pharmacies to organise an authority script, making follow-up GP and practice nurse appointments, printing test results/imaging for patients to take to specialists and allied health professionals, and social security and insurance paperwork.
That was in addition to the four out of 10 encounters that involved writing referrals to other healthcare providers.
“As the video recordings are identifiable, they can only be accessed via one of four secure terminals within the main office of the Digital Library,” the researchers made clear.
“No remote access is possible. Any researchers planning secondary analysis of the video recordings must first discuss this project with the Digital Library team and subsequently submit an application for access, with evidence of ethical approval for their study, to the Digital Library lead and advisory group for consideration.
“Our study showed what is really happening behind the closed GP consultation door. As doctors we recognise the mental load of comprehensive general practice,” said lead author and GP Adjunct Professor Liz Sturgiss from Monash University’s School of Primary and Allied Health Care.
“But there is also joy in providing whole-person care,” she added.
Understanding the complexity of general practice was essential for health system and workforce planning and training, Professor Sturgiss and her co-authors, Dr Kimberley Norman, Ms Nilakshi Gunatillaka and rural GP Dr Kellie West, reminded readers.
“General practice is a generalist specialty that values non-fragmented, whole-person care as an efficient and effective approach to healthcare.
“This study of recorded consultations allows us to see the whole-person care that is delivered by general practice that often crosses multiple body systems. When we only look at primary care as a series of tasks, we risk fragmenting healthcare to a point that it becomes less efficient, takes more of the patient’s time and is less effective as the patient is seen in parts and not as a whole,” they concluded.
