GPs crack down on ‘laundry list’ patients
Overworked Waikato GPs are cracking down on patients presenting for appointments with a laundry list of complaints.
In some cases patients arrive with 10 problems – “just impossible” in 15 minutes – but doctors acknowledge longer wait times aren’t helping.
Te Awamutu Medical Centre is the latest to implement a “one main problem per consultation” policy.
And patients can expect more of this in a health system that’s under pressure, according to a GP leader.
Te Awamutu Medical Centre practice manager Wayne Lim says “there's a limit to what can be covered in a few minutes” and doctors have been practising this model for decades.
Yet consultations are getting more involved at times of staff shortages, making it difficult to keep the system running under the current 15-minute model, maximise time available to patients and not overload the doctors.
GPs were burdened with increased paperwork and administration “to get referrals sent off and follow to each consultation done”.
Lim also acknowledged longer waits to see a doctor could mean patients arrived with more things to talk about.
Wait times at his centre were between three days and three weeks on average, depending on “whether you need or want to see your GP consistently or you're happy to see someone else”.
A 15-minute appointment cost $55 for ages 24 to 65 years and $50 for patients over 65.
Over at Fairfield Medical Centre, Dr Paddy Bhula said patients could discuss a maximum of three minor concerns with him in 15 minutes. Yet some brought a list of 10 problems which was “just impossible”. It was an unsaid rule and not a policy to discuss the primary concern during an appointment.
The centre was also going to have to start charging for a previously free online patient portal due to financial pressures.
“It adds to our paperwork load, but doesn't necessarily add to our income.”
And at Rata Health, it’s suggested patients come to their doctor with “one major or two minor issues”, or book a second appointment if they have several complex issues.
But the one problem policy isn’t a cure-all. Dr Navin Rajan from Tui Medical Centre said it looked good on paper and financially viable, but was “extraordinarily difficult” in reality.
Tui Medical implemented this policy about five years ago, he said. While some patients could afford an extended consultation, many couldn’t. And booking extra appointments for a patient made it harder for others to be seen.
“You're dealing with the same pool of available appointments.”
Rajan said the policy enforcement was only a symptom of a bigger problem – under resourced GP services.
GPs have been sounding the alarm about finances and “many are reaching breaking point”, General Practice Owners Association of Aotearoa New Zealand (GenPro) chairperson Dr Angus Chambers has said.
By the end of January, more than 155 practices had filed formal notices to warn they might have to cut services if the Government doesn't fully fund a nurse payment equity claim, he said.
With the system under pressure, it’s becoming more common for clinics to implement this policy, said Dr Luke Bradford, director at The Royal New Zealand College of General Practitioners. “It is a double edged sword”, as patients received better service for the primary concern, but addressing multiple issues would become expensive.
This kind of policy isn’t new, Pinnacle clinical director Dr Jo Scott-Jones said, but it’s highlighted because of “immense strain” on the health system.
“Overburdened by workload, workforce shortages, and inadequate funding, many practices are struggling to deliver the quality care they strive for.”
Scott-Jones acknowledged the 15-minute model did not work for every individual and situation, but it was a reality GPs operated in. Keeping to time would help reduce appointment overruns, ultimately easing pressure on booking and wait times, he said.