Does patient age and education affect consult length?

What influences the length of a GP consult?
 
Is it just the number of medical issues raised? Does the way these are communicated, and whether the patient or GP initiates the discussion matter? What about the patient’s age and education?
 
These were questions that Dr Sarah White, Kompal Sinha and Irene Simpson were looking to shed light on in research published last month in the Health Literacy and Communication Open journal.
 
The research included analysis of 41 consultations involving three Sydney GPs that were videoed from 2018–19.
 
These consults all involved patients aged 18 and older who spoke English fluently, and were then linked to patient surveys which included data on age, gender, main language, relationship status, education and occupation.
 
Authors found factors beyond the number of medical concerns can influence consultation length.
 
They note that the time of a standard-length consultation, from six to 20 minutes, can be limiting for patients with several presenting concerns or complicated concerns, as well as for younger people.
 
The authors also note the possible influence of a patient’s education.
 
‘Our analysis found patients educated beyond high school with tertiary education … had shorter consultation length compared to the base case which included patients with school or Higher School Certificate completion,’ they wrote.
 
The authors suggest this could reflect higher health literacy, noting that there was no reduction in the number of concerns raised per consultation by patients with higher education.
 
‘Future policy development and workload planning should consider aspects of patient age and education when determining consultation length,’ they wrote.
 
Ms Simpson, who is currently a PhD candidate at the University of New South Wales, said the issue is particularly relevant to younger patients who tend to visit their GP less.
 
‘The reason why we’re focusing on younger people is because they often bring multiple, very distinct concerns that are new,’ she told newsGP.
 
‘It would be great if younger patients [are] able to book a longer consultation just so they can structure out their problem presentation and concerns in the time.’

However, with the structure of MBS rebates favouring shorter consultations, she suggested ‘upfront agenda setting’ could be another approach.
 
While the paper references that consult agenda-setting is part of RACGP training, Dr White, an expert in health communication, told newsGP there is scope for it to be used more widely.
 
‘With upfront agenda setting, it doesn’t happen that often,’ she said.
 
‘Even though it’s advised … it’s a weird thing to do.
 
‘That’s the reason why it doesn’t happen because it does feel awkward to say “you’ve told me this problem, now tell me another problem”.
 
‘The other thing that was found in the research was that if there was a director of the consultation, if someone took the lead a bit more and was introducing those kinds of things, then it was a slightly shorter consultation.
 
‘That can be the patient or the doctor.’
 
The study did not look at the length of the existing clinical relationship between the GPs and their patients, nor how often the patients visited – areas the authors suggested for further research to understand their impact on consultation length.
 
They also acknowledged that results from the small dataset may not represent the broader population.
 
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consult health communication item 23 level B MBS Medicare