Consultation length and chronic illness care in general practice: A qualitative study

Objective: To study the relationship between duration and content of general practice consultations for patients with chronic conditions. Design: A qualitative analysis of transcripts of consultations. The major themes and concepts of psychosocial support were identified and coded using the Ethnograph computer package. Setting: A mix of rural and urban general practices in two States of Australia in 1993-1994. Participants: 14 selected general practitioners and 50 of their patients with complex chronic conditions. Results: Transcriptions of 106 consultations were analysed. General practitioners (GPs) led most consultation dialogue and emphasised disease management. The major themes were provision of information by the GP, review of treatment by the GP, review of illness by the GP, and description and explanations of their illness by patients (patient narrative). The first three themes predominated in consultations of all lengths. Longer consultations (20 minutes and over) contained more dialogue initiated by patients and more patient narrative about living with their illness. Conclusions: Patients with complex chronic conditions may require longer consultations to allow adequate time for review of their illness and treatment as well as an opportunity to raise issues and concerns about their illness, its impact on their lives and their personal management strategies. Longer consultations may thus provide the mechanism for what has been described as patient 'enablement'.