Perceptions on Multi-Issue Consultations in an Irish Primary Care Setting

Shane Dunlea

Keywords: "Primary care" "consultation" "multiple-issues" "General practice"

Consultations involving multiple issues are a common feature of general practice (GP), which have implications for both doctor and patient in terms of time allocation, structuring of the consultations, and safely addressing and following up on all issues involved.

Research questions:
This research project was a basic descriptive study in which the perceptions and attitudes of both doctor and patients were explored in relation to consultations involving multiple issues.

All GP trainers and GP trainees of the fourteen Irish National Training Schemes were invited to complete an anonymous online survey. Patient participants were recruited from the waiting rooms of two Dublin based practices. The data from both surveys were then collated and analysed to identify any patterns that emerged.

The results of the doctors’ survey showed the perception of a high incidence of consultations involving multiple issues (mean number of issues per consultation 2.52). The majority of doctors (65%) favoured a policy of capping number of issues per consultation, but only 7% of practices had such a practice policy in place. A variety of strategies were used in multi-issue consultation by doctors. The majority of doctors (65%) indicated their management of these consultations was influenced by whether the patient was a private or public patient. These consultations were found to adversely impact upon doctors’ time management, stress level, and act as a source of concerns regarding clinical safety. The patient survey indicated the average number of issues brought to the consultation was 1.37 and the average number of issues patients felt it was reasonable to address in a consultation was 2.29. “Being able to address all issues brought on the day” was ranked highly important by patients.

Multiple issues consultations are a common feature of the GP consultation and a common source of stress for doctors.

Points for discussion:
How common are multiple issue consultations?

How do multi-issues consultations impact GP’s

What are the strategies that can be used, and are used, in this type of consultation.