Doctors in India see patients for barely two minutes on average, according to a global study which found that primary care consultations last less than five minutes for half the world’s population, ranging from 48 seconds in Bangladesh to 22.5 minutes in Sweden. While India’s primary care consultation time was two minutes in 2015, the mean duration was just 1.79 minutes in 2016 in neighbouring Pakistan, the largest international study on consulting time, published in the British medical journal BMJ Open, found. “Shorter consultation times have been linked to poorer health outcomes for patients and a heightened risk of burnout for doctors,” researchers wrote in the journal. As demand for primary health care rises around the globe, the length of a consultation has increasingly come under pressure. To tease out the potential impact on patients and the wider healthcare system, the researchers reviewed the data on consultation length from 178 relevant studies covering 67 countries and more than 28.5 million consultations.
They included both peer reviewed research and the ‘grey literature’ – research produced outside of traditional academic or commercial channels – published between 1946 and 2016 in English, Chinese, Japanese, Spanish, Portuguese and Russian. “The results showed that average consultation length varied widely, from 48 seconds in Bangladesh, to 22.5 minutes in Sweden,” researchers said.
Commenting on the study findings, Dr Aashish Chaudhry, Managing Director and Orthopedic Surgeon, Aakash Healthcare in New Delhi said, “This figure does not represent the entire spectrum of medical professionals offering consultations to patients.” “The figure of two minutes is indeed a gloomy figure, but largely it represents doctor’s consultation time in government hospitals where patient load is massive, and most of the time one doctor has to see more than 100 patients in one to two hours on an average,” Chaudhry said. In 15 countries, which represent around half of the world’s population, the appointment lasted less than five minutes. And it lasted under 10 minutes in a further 25.
“Little can be achieved in less than five minutes unless the focus is largely on detection and management of gross disease,” suggest the researchers. “An average of five minutes may be the limit below which consultations amount to little more than triage and the issue of prescriptions,” they said. “The time also depends on many factors including the disease, pain intensity, urgency of the problem, apprehension and anxieties of the patient, which need to be addressed to the patients’ satisfaction,” Chaudhry added.
“There have been times when I have completed the consultation under five minutes, and I have also given more than an hour to a single patient to address all of their concerns,” he said. In developed countries, average consultation time seemed to steadily increase: by 12 seconds a year to over 20 minutes in the US; and by just over four seconds a year to 10 minutes in the UK. Consultation length seems to be shortening in some low and middle income countries, which may have important implications for population growth and the expansion of treatment options, researchers said.
Shorter consultation length has also been associated with multiple drugs prescribed to a patient (polypharmacy), overuse of antibiotics, and poor communication with patients, they said. Although this is the largest international review of consultation length to date, the researchers highlight that the quality of the evidence was graded ‘good’ in less than half the included studies. Differences between rural and urban, and public and private practices, were not taken into account, they said.