Is it better to see your GP in the morning or afternoon?
A new study says doctors feel ‘drained’ by lunch, but have more time later in the day. Chloe Lambert explains
How was your last GP appointment? Was the doctor perky, switched on and sympathetic, or red-eyed, tetchy and staring at his screen? A study has found that the time of day at which you have your appointment could make all the difference to your experience.
In a poll of 1,681 GPS by Pulse magazine, more than half felt they were overworked, with doctors reporting feeling drained of empathy by lunchtime and worried that fatigue was putting patients at risk. “By lunchtime, I felt on the edge and risked missing urgent tasks and contacts, thus affecting patient safety,” said Dr Jonathan Harte, a Nottinghamshire GP.
So, if you do have the luxury of choice, is the morning the best time to see a doctor?
GPS have a post-lunch slump
Last week’s survey found family doctors were dealing on average with 41 patients a day, despite the fact that 30 is considered a safe number.
“We’re only human, and like everyone else, GPS get tired and hungry and irritable by the end of the day,” says Dr Neil Bhatia, a GP in Yateley, Hants, who says he regularly has 40 patient contacts (telephone calls, appointments and emails) in one shift. “It’s true that by the time I see the last patient of the afternoon, I sometimes have to work hard to maintain concentration.
“I like to think it wouldn’t impact on the assessment and overall outcome, but there have probably been times when a patient has felt a consultation was more rushed than it could have been,” he adds.
“There are things you might tell them to come back for that you would have done there and then, if it had been the morning. You might take a blood test yourself, for example, rather than telling them to schedule another appointment with the nurse.”
GPS are better supported in the mornings, Dr Bhatia says, with extra staff such as nurses in the surgery, so tests or procedures, such as ECGS (electrocardiogram) or blood tests, tend to be done more quickly. “If you need a urine sample sent off for testing, and you come in late in the afternoon, you might have missed the last collection of the day,” he adds.
One London GP, who preferred not to give her name, has experienced compassion fatigue after seeing a series of patients with multiple, complicated issues. “I found myself thinking, ‘oh God, not another one’, which I knew was a sign of burn out,” she says. “The workload meant I was no longer seeing the person in front of me.”
But you’ll be given more time in the afternoon
Even though GPS, like many of us, work better in the mornings, some say that after lunch their surgery becomes less busy and so they may have more time for each appointment.
“At my practice we organise our own appointments, and because I know I’m a bit slower in the afternoon, I tend to space them out a bit more,” says the female London GP.
Dr Zara Aziz, a Bristol GP, adds: “If I have a patient with complex needs, I might book them in for the end of the morning or the end of the afternoon, so I can give them more time.”
Sheila Wells, a former GP receptionist who writes for a blog titled “Beyond The Receptionist Desk”, says she prefers afternoon appointments when she needs to see a doctor. “People have it set in their minds that earlier appointments are best, but I find the afternoons are less busy and the doctor is a bit more relaxed – and the waiting times are often a bit better.”
Many GPS now work part time, or do late shifts so they can see patients in the evenings, she adds, so it’s not
‘People think that earlier appointments are best, but I find the afternoon less busy and the doctor a bit more relaxed’
always the case that they’ll feel under most pressure in the afternoons.
The patient can play their part
Patients can help to ease logjams – and get seen more quickly – by being upfront about the nature of their complaint. Receptionists, who are bound by patient confidentiality, may be able to arrange a telephone appointment, a consultation with a specialist nurse, or may advise a patient to see a pharmacist.
“There’s a legacy of patients, usually aged 70 to 90, who grew up with the idea you see your GP face-to-face,” says Dr Bhatia. “But it’s worth asking whether you need to be physically seen. If it’s advice on medication, for example, you probably don’t. We offer lots of telephone appointments and I give my email address to all my patients.” Appointment systems vary from practice to practice – some now operate “phone triage”, where every patient speaks to a GP on the phone before the doctor decides if they require a face-to-face consultation.
Have your flu jab before noon
Previous research has shown morning is the optimum time for various medical procedures. Doctors doing colonoscopies are more likely to spot abnormal growths in the morning than in the afternoon, according to a study in the American Journal of Gastreonterology, with researchers blaming doctor fatigue. In 2006, a team at Duke University in North Carolina, US, found surgery goes more smoothly if carried out before noon, with the risk of complications related to anaesthesia rising from 1 per cent at 9am to 4.2 per cent by 4pm. Fatigue was again blamed, but the report’s authors also speculated that patients’ tolerance to pain might vary throughout the day.
Even vaccinations seem to be more effective earlier in the day. In 2016, the University of Birmingham reported that flu jabs given in the morning produced a greater, and thus more protective, antibody response. Dr Anna Phillips, the lead author, said immune responses fluctuated throughout the day, adding that the findings could help improve vaccination strategies.
Don’t wait till Friday to see your doctor
It’s widely agreed that GP surgeries are busiest on Monday mornings, so this might be a time to avoid if you can. “Things appear over the weekend, and people hang on because they don’t want to go to A&E,” says Dr Bhatia, adding that Tuesdays after bank holiday weekends can also be hectic.
“Friday afternoons also tend to be busy because people suddenly realise their problem can’t wait over the weekend,” adds the London GP.
We often consider Saturday night to be the worst possible time to visit emergency departments, but in fact Monday mornings are the busiest, with 16 per cent of attendances, compared to 13.8 per cent on Thursdays, Fridays and Saturdays, according to data from the NHS.
Experts say this is because elderly patients may deteriorate over weekends and are then admitted. However, previous research showed heart attacks and strokes peaked on Mondays – possibly because of the stress of returning to work.