At finals you could spend 20–40 minutes clerking your patient. So how can a 10-minute consultation in general practice produce an adequate assessment?
- Continuity of care means the patient and their history are often familiar.
- The 10-minute consultation is an average. A quick consultation, like a repeat medication request, saves time which can be spent on trickier problems.
- You don’t need to do everything in one consultation. It can help to watch a problem develop over several visits.
- Making diagnoses is honed through practice, enabling GPs to recognise patterns of illness quickly. This is not ‘taking short-cuts’: it’s about the expertise to focus on key areas.
As a student, don’t rush to assess a patient in 10 minutes. Take the time you need to understand your patient’s problem fully. Speed comes with experience.
What’s the Difference between a Focused History and a Traditional One?
- Traditional history-taking is useful when you first learn to interview patients as it teaches you a structure and a list of questions to ask.
- You’ll notice senior doctors often ask surprisingly few questions, yet get a better view of the problem.
- This ‘focused history’ requires judgement about what to explore and what to set aside. Judgement is based on many things including knowledge and experience.
- Learning focused history-taking is an important transition between student and doctor. General practice is the ideal setting to practise this because you will see many undiagnosed patients on whom to hone your skills.
Focused History-Taking in a Nutshell
Listen
- ‘What can I do for you today?’ Students often hope to save time by getting straight to the point with direct questions. The opposite happens. You get a better foundation for exploring the problem if you give the patient the time to tell their story from their perspective: start with an open question and then listen.
- The ‘golden minute’ (give the patient a minute to speak without interruption) gives your patient time to frame their problem in their own way.
- ‘Go on … tell me more …’
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