The doctor will see you now - but often not for long

(Reuters Health) - For half of the world’s population, primary care doctor visits last less than five minutes, researchers say.

Appointments range from 48 seconds in Bangladesh to 22.5 minutes in Sweden. In the U.S., meetings with doctors average about 20 minutes.

Shorter consultation times have been linked to poorer health for patients and burnout for doctors, Dr. Greg Irving of the University of Cambridge in the UK and his colleagues note in a report in BMJ Open.

The researchers reviewed 178 earlier studies written in English, Chinese, Japanese, Portuguese, Russian or Spanish, covering 67 countries and more than 28.5 million appointments.

Eighteen countries, which account for half the world’s population, have appointment times less than 5 minutes, they found. Another 25 countries had appointment times under 10 minutes.

In developed countries, consultation times seem to be increasing. In the U.S., for example, appointments are bumping up 12 seconds a year and have moved from 15 to 20 minutes over a short period of time.

With longer appointments, “you see more health promotion and conversation with patients,” Irving said.

“The next question is whether patient satisfaction goes up, too,” he told Reuters Health by phone. “Even if you have 30-40 minute appointments, there’s no guarantee patients will be happy.”

Consultation length seemed to drop in low- and middle-income countries, which may have implications for population growth and treatment options. China, for instance, averages around two minutes for appointments. The government recently announced a new policy to expand the primary care workforce.

Future studies should look at the added value for each additional minute of consultation, Irving said. The differences between a two-minute appointment and a 20-minute appointment may be obvious, but researchers want to know the difference between what is covered in a 15-minute versus a 20-minute appointment.

“At what point do qualities such as health promotion begin to creep into the consultation?” he said. “What times help us best manage our patients’ health?”

Irving’s team found that consultation length was associated with national health care spending, the number of primary care doctors per 1,000 residents, and doctor burnout rates. At the same time, appointment length wasn’t associated with the number of consultations per patient each year, the number of diagnostic tests requested by the doctor, the number of emergency care department visits, or patient satisfaction.

The correlations between consultation times and outcomes may become increasingly important as the industrialized countries’ populations age, said Robin Osborn of the Commonwealth Fund in New York City. Osborn, who wasn’t involved with this study, and colleagues conducted a study with primary care physicians in 20 countries in 2015 that looked at the challenges of caring for patients with increasingly complex health needs.

To ensure affordable, high-quality health care for sick and complex patients, a strong primary care infrastructure is needed, she told Reuters Health.

SOURCE: BMJ Open, online November 8, 2017.