The content of general practice consultations: cross-sectional study based on video-recordings

Objectives: To describe the number and types of problems discussed in general practice (GP) consultations, differences between problems raised by patients or doctors, and between problems discussed and recorded in medical records. Design: Cross-sectional study based on video-recordings of consultations. Setting: 30 representative GPs from 22 general practices in Bristol and North Somerset Participants: Adults making a pre-booked day-time appointment. Main outcome measures: Number and types of problems and issues discussed; who raised each problem/ issue; consultation duration; whether problems were recorded and coded. Results: Of 318 eligible patients, 229 (72.0%) participated. On average, 2.5 (95%CI 2.3 to 2.6) problems were discussed per consultation, with 41% (55/229) of consultations involving at least 3 problems. 72% (165/229) of consultations involved problems in multiple disease areas. Mean consultation duration was 11.9 minutes (95% CI 11.2 to 12.6). Consultation duration increased by 2 minutes per additional problem. Most problems discussed were raised by patients, but 43% (99/229) of consultations involved problem(s) raised by doctors. Patients and doctors raised different types of problems and issues. Of 562 problems discussed, 81% (n=455) were recorded in notes, but only 37% (n=206) were Read-coded, with differences between types of problems which were coded or not. Conclusions: Consultations in general practice are complex encounters addressing multiple problems across a wide range of disease areas in a short time. Additional problems are dealt with very briefly. GPs, like patients, bring an agenda to consultations. There is systematic bias in the types of problems coded in electronic medical records databases.