Family Practice Vol. 20, No. 3, 262-269
© Oxford University Press 2003
Communication |
GPs’ perspectives on managing time in consultations with patients suffering from depression: a qualitative study
Department of Medicines Management, Keele University, Staffs ST5 5BG, UK.
Correspondence to Kristian Pollock; E-mail: k.pollock{at}keele.ac.uk
Pollock K and Grime J. GPs’ perspectives on managing time in consultations with patients suffering from depression: a qualitative study. Family Practice 2003; 20: 262–269.
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Abstract |
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Background. Although there is widespread concern that general practice consultations are too short for doctors to provide a high quality of care for patients, the relationship between the length and outcome of these consultations remains unclear. Research to date has neglected the subjective experience of consultation time of both patients and GPs.
Objectives. Our aim was to investigate GP perspectives on consultation time and the management of depression in general practice.
Method. A qualitative interview-based study was carried out of 19 GPs from eight West Midlands general practices.
Results. The GPs in this study acknowledged the pressure of work and resource constraints in general practice. However, they did not feel these prevented them from providing good support and treatment for depression. They were confident in the effectiveness of antidepressants and their own skills in providing counselling support, and were able to utilize time flexibly in responding to patients’ variable needs. Depression was viewed as a relatively straightforward problem that usually could be managed within the resources available to general practice.
Conclusion. The doctors generally did not experience time to be a limiting factor in providing care for patients with depression. This is in contrast to the more acute sense of time pressure commonly reported by patients which they felt undermined their capacity to benefit from the consultation. GPs need to be more aware of patient anxieties about time, and to devise effective means of raising patients’ sense of time entitlement in general practice consultations.
Keywords. Consultation time, depression, general practice.
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Introduction |
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There is widespread concern that time shortage in medical consultations is a major constraint in general practice and a limiting factor in the quality of care provided for patients. Recent research and reviews report a mean consultation time of 8 minutes1–4 despite a range of appointment intervals between different practices2 and consultation length between different doctors.2,4–7 Consultation length actually has increased over the last several decades.4,8,9 However, it is argued that the demands on GPs’ time have also intensified, with more complex consultations involving a greater number of tasks.8,9 Some research findings point to a direct relationship between consultation length and quality of care.1,8,10–13 However, other findings are more equivocal, and suggest that additional factors, such as case mix and the skill of the practitioner in using time well, rather than simply how long the consultation lasts, are more important determinants of outcome.2,4,6,14,15
Psychosocial distress is reported to constitute a significant amount of morbidity in primary care.3,16–18 Shortage of time has been implicated as an important factor in GPs’ failure to detect up to half of the cases of depression among patients consulting in general practice.3,17,19 Hurried consultations in which there is pressure to get through a complex series of tasks and issues are not conducive to the disclosure and recognition of depression. However, the relationship between the length and outcome of medical consultations, including those for psychosocial problems, is clearly complex and remains unresolved.20 So far, discussion about the time and quality of consultations has paid little attention to the direct experience of GPs and their subjective judgements about the adequacy of time as a resource in general practice.17 In the present article, we report the findings of a qualitative study of GPs’ views about the diagnosis and treatment of depression which relate to their accounts of how they manage time in consultations with depressed patients. These findings are considered in relation to a summary of the patient perspectives and experience of time21 to provide a comparative framework for contextualizing the results of the study and their significance.
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Method |
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The research involved qualitative interviews with patients, GPs and counsellors that were analysed comparatively to explore differing perspectives on the nature of depression and the effectiveness of its treatments. This paper presents findings relating to the GPs’ experience and management of consultation time. A detailed account of patient perspectives of time in the consultation is given elsewhere.21 Nineteen GPs were enlisted from eight West Midlands practices through a process of rolling recruitment in which practices were selected purposefully to cover different socio-economic and geographical settings, and patient list size (Tables 1 and 2
). We did not aim to recruit a representative sample of doctors within a qualitative study of this type. It is likely that the GPs in this study became involved in the research because they had a particular interest in depression and were confident in their ability to treat it. In this respect, they may not be typical of many of their peers. However, our respondents extended across a wide spectrum of different ages, practice type and working experience, enabling us to explore a range of different views and perspectives. The research was approved by a Local Research Ethics Committee.
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GP interviews
Interviews took place in the doctors’ offices and most lasted about an hour. Informed consent was obtained from the GPs who received an honorarium in recognition of the time they contributed to the interview and patient recruitment. The interviews were taped and fully transcribed for content analysis22 using the NUD*IST qualitative data analysis software program. Recording failed in one interview, which was typed up from extensive notes immediately afterwards. All interviews, coding and analysis were carried out by the authors. The tape recordings were stored in a locked filing cabinet, and all personal and identifying details were removed from the transcripts. Interviews were loosely structured round a topic list which served as a prompt for the interviewer to cover a range of core issues relating to respondents’ ideas about the cause and diagnosis of depression, the management of consultations and the duration and effectiveness of treatment. Neither the order of topics nor the wording of questions were standardized.
Data analysis
Coding categories were developed from identification of themes arising from repeated scrutiny of the interview transcripts and field notes.23 A coding frame was developed through an iterative process in which both authors worked independently on the data and then checked their analysis with each other. Inconsistencies were resolved through discussion and further reflection. Some themes, such as the recognition and treatment of depression, were obvious, and of predetermined interest. Others emerged in the course of analysing the transcripts, and time was one of these. Four more specific themes are discussed in the present paper: consultation length; time and disclosure; managing time; and antidepressants and time. An extended account of the research methodology is given elsewhere.24
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Results |
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Consultation length
Most of the doctors worked with standard booking times of 8 or 10 min appointments, with a number of shorter emergency ‘fit-in’ appointments being allocated within each surgery. One single-handed GP operated a system with only open access and no booked appointments. However, it was evident that the allocated time was fairly nominal and that the length of consultations varied widely. Several GPs specified that they made an effort to keep to time, and were reasonably successful in doing so. However, there was agreement among all the GPs that consultation lengths were determined primarily by clinical need rather than allocated time. Most were fairly sanguine about the extent to which their surgeries over-ran as a result (Box 1
). There was agreement also that dealing with depression typically required longer than most other conditions dealt with in general practice. This was particularly true of the first consultation, which often considerably over-ran the booked appointment time (Box 1). First consultations for an episode of depression were reckoned to take two or three times as long as routine visits, typically lasting 
20 min. GPs could accommodate these through their willingness to run over time with their surgeries and because there was consider-able flexibility in allocating less time to other patients whose needs were dealt with more quickly and easily (Box 2).
Time and disclosure
The GPs that were interviewed recognized that patients may find it difficult to start discussing psychological problems. They were concerned not to miss a diagnosis, especially when cues that this might be the underlying problem emerged slowly during a consultation. Judging the severity of the problem was important and sometimes (though not always) took time. Although not reported to be included routinely, asking about suicidal thoughts or intentions could not be rushed (Box 3). Several GPs referred to the phenomenon of ‘doorhandle disclosures’ when the issue of depression was raised when the patient was preparing to leave, presaging the start of a whole new consultation. This raised a dilemma: to respond appropriately meant running over time, but having raised a query about psychosocial problems the GP could not at that point quickly close the consultation down (Box 3).
| Box 1 Length of consultation Over-running time was common "No, I don’t keep to my times that rigidly. I give them how long any of them need, and that is depression or anything else, really." (GP504) "I guess that my surgeries tend to run on longer (laughing), erm . . . that is fairly well known." (GP606) "It is just the same one appointment booked, sort of we control the length of the consultation, so I don’t mind running late." (GP503) Initial consultations for depression often took longer ". . . this is why my surgeries run over! No, I mean, we book in at ten minutes but you are looking really at twenty minutes. These are the sorts of things that put you well back . . ." (GP604) "I mean, basically in this practice we . . . stick pretty closely to appointment times, ten minute appointments tend to be around ten minutes. But sometimes you have to spend forty minutes and—it is rare that I do that—it is not uncommon to spend twenty to thirty minutes with someone." (GP511) I: "So, how long does this kind of consultation last?" R: "Twenty minutes, half an hour." (GP605)
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| Box 2 Flexible time Time could be allocated flexibly according to case mix "No, I mean everyone gets the same theoretically, the same amount of time. Someone with tonsillitis will go out quickly. Somebody with depression gets a bit longer." (GP504) ". . . I am also one of these people that if they only come in for a sick note they will be in and out in two minutes, so that I can keep the time for the ones that need more . . ." (GP507) "You just hope you’ve got a sore throat afterwards, or somebody cancels or doesn’t turn up." (GP603) New or demanding consultations involving depression were not common ". . . obviously that is difficult, if you have got sort of five people coming in with that. But, I mean, that is unusual. You do only usually get one of these in the midst of the surgery." (GP508)
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| Box 3 Disclosure time Establishing the severity of depression could take time ". . . it is nice to feel confident at the end of a first consultation, first of all that you are not missing somebody who is severely depressed and at risk, and withholding themselves. I think that is always something . . . in the back of a doctor’s mind when they are seeing somebody with depression. But, erm, I think that in allowing time to talk about their symptoms that that . . . shouldn’t be too much of an issue because, erm . . . the people will offer information so it reassures you that they . . ."(GP601) The timing of patients’ disclosure could cause problems "Because the time factor, that is the great problem as to whether to move (to ask about psychosocial problems) towards the end of the consultation?" (GP512) "You can’t do that. You can’t do that. If they come and they start to talk about something and you say, ‘Well, you’re time is up. Come back next week’, they won’t talk about it." (GP502)
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Although depression was encountered commonly in general practice, new or severe episodes were not. While the GPs who were interviewed were generally ready to respond by giving extended time to such cases, they were not called on to do so very often (though depression was obviously not the only presenting condition necessitating a long and complex consultation) (Box 2). The first consultation required time to draw out the patient’s concerns, to provide reassurance that these are legitimate problems to bring to the doctor, and to be confident about the severity of the problem. The GPs interviewed were sensitive to the risk of rebuffing patients if they failed to provide appropriate acknowledgement of patients’ problems, and sufficient encouragement for them to disclose these in the consultation. They recognized the value for many patients of being able to unburden themselves in this way. Nevertheless, a primary focus of the first consultation was investigative: to accomplish the tasks of diagnosis, evaluation and treatment. Once this initial work had been done, subsequent consultations tended to be relatively routine affairs which could be accommodated more easily within a standard appointment (Box 4).
Managing time
The GPs that were interviewed recognized the necessity of extending appointments with depressed patients. They also looked on this as an investment, particularly in relation to first consultations. Taking time to establish their understanding of the problem, and develop the patient’s trust and confidence would result in a more effective response to treatment, and save time later. Even within a short time, certain key tasks could be accomplished, preparing the ground for future consultations (Box 5). A varied case mix allowed a considerable degree of flexibility in allocating time to consultations according to the needs presented by patients. Skimping on consultation time early in a case of depression could turn out to be a false economy. Although the GPs interviewed tended to be fairly relaxed about time management and the overall availability of time, there inevitably were constraints that had to be accommodated. The amount of time given to patients was at least partly determined by situational factors (including individual doctors’ tolerance of running late), as well as perceived need (Box 5).
Closing down a complex consultation—in some cases even an initial presentation of depression—with the offer of quickly arranged subsequent and sometimes explicitly extended consultations was one of several strategies mentioned by the GPs that were interviewed in managing time. Several respondents explicitly referred to the scheduling of a sequence of several standard appointments as constituting an extended consultation (Box 6).
Another way of managing the variable demands of time was simply to accept that other patients should be forced to wait for their turn to see the doctor. Several GPs commented on patients’ tolerance of this state of affairs, and their interpretation of a crowded waiting room and long delays for their appointment, as a sign of a committed and caring doctor (Box 6). In an effort to achieve a better fit between supply and demand, one practice had experimented successfully by allowing patients to select the booking period (short, standard or long) they felt was appropriate for discussion of their problem. However, this scheme had been discontinued due to staff shortages within the practice.
| Box 4 Follow-up time Follow-up appointments could often be incorporated within standard booking slots "When they are coming back, sometimes that can be a ten minute, a normal appointment. In fact, it usually comfortably is, you know. But an initial consultation, I think that is very difficult to cover in ten minutes." (GP601) ". . . depends . . . I mean, at the beginning it often takes quite a long time, erm . . . but then sometimes when they come back and they are feeling better and they are happy to take the tablets, then it doesn’t take very long at all, you see." (GP510) Sometimes a longer time could be scheduled for further appointments "I must have been an hour behind when I finished this morning, but, I mean, once it’s happened once, then you can plan ahead and put them in for twenty minutes next time, instead of ten. Once you’ve engaged that there’s a problem there." (GP608)
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| Box 5 Managing time Investing time "I think that it is very important to be able to . . . allow them to talk about things . . . if you don’t allow patients who are depressed time to . . . say in a first consultation, then I think that is time lost, really." (GP601) "Yes, they are long, aren’t they, some of the depression, erm . . . we run ten minute appointments, and you over-run a bit . . . BUT I think that time spent actually on the initial consultation is probably sort of money in the bank for next time." (GP506) "What you have to do is make it clear to people that they have done the right thing about coming in, you are interested and you are going to try and sort it out, because then if necessary you can get them to come back. But what you mustn’t do is . . . shut the door in their face and then they don’t come back . . . The main thing is to make it clear on the first consultation that you are interested and you can, to be honest, you can actually, when you are used to dealing with people you can actually achieve an awful lot in sort of ten to fifteen minutes." (GP508) Situational constraints on time "It’s very difficult to get through a new depressive in ten minutes, so it’s going to expand. It will depend very much how pressured I feel how much time I’m going to spend within the initial interview. If . . . mmm . . . if it’s the last patient in evening surgery or something, then I’m quite happy to go on for half an hour if necessary. If I’m already running half an hour late and I’ve got another twelve waiting then I’ll usually explain to them . . . (and) make a double appointment . . . to come back and see me in the next day or two. They usually accept that." (GP604)
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| Box 6 Strategies for managing time Extending the consultation across time ". . . and offer to break it up, saying we don’t have to finish now, you can come back in a week, or whenever you wish. So it is an extended consultation, really." (GP512) "I commonly don’t do everything in one, I tend to spread it out so that you are actually making more time that way, which I think is a very reasonable use of time." (GP503) "Depending on how that (first) consultation went I might cut it shortish, if I felt it was OK to do that, by saying, ‘Look, there’s lots that you want to talk about and I think we need to talk about more, so make another appointment, make it longer and come back and see me’." (GP609) Extending the time that patients wait ". . . because I normally run on time most of my patients know that, so if I run late the majority of them will say, as I apologise as the person comes out, they will say, ‘Ooh, well, obviously somebody needed more time than . . .’ . . . most people are reasonable and like to think, ‘Well, if I needed that time I would get it,’ so . . ." (GP507) "Yes, . . . you get a bit hassled at six o’clock on a Friday night, but . . . patients come with the expectation that they may have to wait . . . and so if I spend twenty or twenty five minutes with a patient it doesn’t matter. They don’t get irate and angry and start thumping the receptionists . . . And I think over the years they have got to realise that one day it will be their turn to spend twenty to twenty five minutes with the doctor . . ." (GP502) "You just have to say to people, ‘One day if you are seriously ill’, if they challenge you, you say, ‘One day you will want the doctor to be there’, and, erm . . . patients are pretty good about it, amazingly—I mean I hope I am that tolerant (laughing)." (GP511)
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| Box 7 Referrals and delegating time Scarcity of referral resources "No, we haven’t got that availability to everyone, no . . . it is a time . . . it is a waiting list scenario, we have got a counsellor who comes here and you just know that at the moment if the waiting list is three months, then there is really not a lot of point in referring someone over at that stage, you know. It is just not helpful." (GP503) Delegating time "We have got a very good counsellor . . . that I refer depressions to . . . Erm, I tend not to in great depth explore the Why question myself, but I feel my role is to make the patients recognise that they have got the Why questions that need addressing. There are a lot of factors for that. One is time, one is my own personal expertise, one is my own personal energy." (GP605) "I feel that it would be nicer to be given longer to go into the deeper issues, but realise that this is impossible, which is why I refer on." (GP504)
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A further strategy was referral to another agency, though ease of access and the range of services available were important constraints on individual doctors’ patterns of referral (Box 7). The GPs varied in their interest and confidence in dealing directly with patients’ psychosocial problems and in the amount of time they felt able or willing to give to these. However, virtually all of our respondents considered that the direct support they provided for patients constituted a significant ‘added value’ to their treatment with antidepressants, regardless of whether or not this extended to formal counselling. Even those GPs (about a third) who explicitly adopted a counselling role with patients considered that it was possible to provide effective support within the time constraints of general practice. Some GPs offered counselling across a series of dedicated consultations. Others felt that a considerable amount could be achieved in even a fairly short time, especially in cases of relatively mild or ‘reactive’ depression, when patients mainly needed effective, but not necessarily extensive, support to assist them in developing or recovering coping skills (Box 8).
Antidepressants and time
The GPs who took part in this study acknowledged the pressure of working conditions in modern general practice, that time was limited and that access to specialist services often was inadequate. However, none of our respondents indicated that time constraints impeded their capacity to provide effective treatment and support for depression. Scarcity of counselling resources (either through themselves or by referral) was a source of frustration for some GPs, who felt that more of their patients could benefit from a greater provision in this area. Several of the GPs who were interviewed expressed the view that there was an inverse relationship between giving time and prescribing drugs. Having more time to give to patients, either in active counselling or a more passive listening role, could reduce the need for antidepressants (Box 9). Deep and complex problems were recognized to require an extensive input of time. The GPs were aware that counselling was a popular choice of therapy among patients. Nevertheless, for most cases involving depression, antidepressants were regarded as a very effective treatment, to which counselling could be a useful adjunct (Box 9). Antidepressants were considered to work more quickly than talking therapies, and they had the advantage of being readily available without restriction. Most GPs considered that most cases of depression could be treated adequately (if not optimally) within the resources available to them in general practice.
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Discussion |
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General practice consultations are widely perceived to be too short for GPs routinely to provide a high quality of care for patients, especially those suffering from depression and related disorders.1,8,10–13 Nevertheless, the relationship between the length and outcome of the consultation remains unclear.2,4,6,14,15 Discussion of the relationship between the quality and quantity of consultation time has neglected the subjective experience of both doctors and patients. This paper presents the findings of a qualitative study of the diagnosis and treatment of depression in general practice as they relate to GPs’ accounts of the adequacy and management of time with patients. The 19 doctors in this study acknowledged the pressure of work and resource constraints in general practice, including pressure of time, but did not feel that these prevented them from providing good support and treatment for patients suffering from depression. They considered antidepressants to be an effective treatment, were confident in their ability to provide personal and counselling support for their patients, and felt able to allocate time flexibly in responding to individual need.
Even GPs who did not regard either active counselling or receptive listening as an appropriate use of their time over the long term did not regard patients’ presenting behaviour in relation to depression as inappropriate or time wasting. They recognized the distress that drove patients to the surgery, accepted that many people had nowhere else to turn for support, and were keen to help. For most of the GPs in this study, antidepressants were a major part of, and sometimes a sufficient, treatment for depression. Extended time often was required to undertake the tasks of diagnosis and assessment and to establish rapport with patients experiencing acute distress. Subsequently, once treatment had been initiated, ongoing contact with patients tended to be handled in a more routine manner, within the boundaries of normal appointment and organizational routines.
| Box 8 Counselling time Some doctors explicitly took on a counselling role with depressed patients "I mean, I would usually say to them along the lines of, we should meet and talk a few times, just so that we get to know what we are dealing with a bit better. And then at the end of that time we can maybe discuss what the options are." (GP509) "This is the time where . . . whether you call it counselling, or whether you call it talking to people, you know, you explore things like whether their childhood was happy, whether they were abused, and you know, not uncommonly skeletons come out of the cupboard, and you think, ‘Well, these are things that need to be addressed’." (GP508) Providing effective support for patients with depression need not require an extensive input of time ". . . a lot of counselling I think is just giving time for a patient to talk and to listen and . . . mmm . . . the guidance will come later. And people often leave you at the door and say, ‘I feel much better for having talked about it’." I: "Even just in one consultation?" R: "Even just a ten minute consultation they’ll feel better already having shared it and having someone listen and take me seriously and that’s pretty much part of the treatment." (GP604) "Erm, some people don’t come back but when you see them subsequently with a sore throat or something, they say that it was . . . often they say it was just really nice just having that talk, and then I had a look at what I was doing and changed some things." I: "So it has an effect?" R: "And sometimes, you know you are running late because you have had a twenty minute interview with them, or whatever, and it is just you don’t think you have done anything but to them it is just like somebody has acknowledged that they were struggling and then they were able to get on. You get a lot of that, yes." (GP507)
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| Box 9 The role of antidepressants Antidepressants could be seen as a fast and convenient treatment "I think to some extent we probably use more medication than we would do in an ideal world. If we had free access to rapid psychological services we would probably use them (i.e. the services) more." (GP508) "Erm . . . well, yes, I think that most people that see a counsellor, are on antidepressants, or have been given, certainly given the option of antidepressants. Because it is easier, so much easier to prescribe it. I mean, I don’t know whether that sounds dreadful or what, but it is, you know . . ." (GP510) "I am very proud of the practice. We have always prescribed less antidepressants than the (average) . . . And so I have always taken that to mean that we have time to listen and talk . . . I am proud of the fact that we don’t rush to the antidepressant model." (GP509) In practice, antidepressants were often regarded as the primary treatment for depression I: "And overall, in the recovery how important do you see the medication as being compared to support or counselling?" R: "I think it’s crucial. I think it’s crucial. I think, mmm . . . I think my support is OK. I’m not brilliant because you haven’t got the time to spend as much time as you would like with these people, but I think the drugs are important. I think they’ve been proved to be effective." (GP604) "Yes, I think a lot would recover with just counselling. I tend to think of it (antidepressant treatment) as the acute treatment, get them back on their feet and when they have got stronger, we can then talk about why it happened in the first place. So, yes, they could respond with counselling, although it would be a lot longer." (GP504)
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The GPs acknowledged that time was short, and that being able to spend more with patients would be desirable. However, their accounts did not contain the sense of acute time urgency or anxiety about time that characterized many of the patient responses in this study, which have been reported elsewhere.21 Time management was part of the GPs’ working routine. In contrast to the patients, they had a considerable amount of control over the allocation and use of time in the consultation. They also had a number of strategies for managing time, although the exigencies of general practice inevitably circumscribed the effectiveness of these. Several of the study GPs emphasized the importance of the use of time, rather than its extensiveness.
The GPs who were interviewed lacked awareness of the intensity of patient concerns about time or the extent to which these impaired patients’ capacity to benefit from the consultation. Patients in the study commonly described a sense of marked anxiety about time, and a particular concern not to run over the allocated booking time of 5–10 min.21 They often felt there was not time to disclose fully, or discuss adequately, their concerns, and even that a general practice consultation was not an appropriate setting for dealing effectively with depression. The GPs who were interviewed seemed to be operating with a different sense of time from the patients. Thus, patients did not appreciate the extent to which consultation times could be flexible, or that the doctors were working with a notional ‘average’ length of 5 or 10 min. GPs and patients alike interpreted a crowded surgery and a long wait for booked appointments as an indication of a conscientious and caring doctor. However, while the GPs tended to view this as evidence of their willingness to allocate time according to patient need, the effect on patients was to intensify their sense of time pressure and concern not to over-run the allotted time when their turn came. A long waiting time undermined patients’ already fragile sense of time entitlement and inhibited their disclosure of problems when they did get to talk to the doctor.19 In effect, patients took upon themselves the task of rationing time in the consultation.25 Some GPs in the study referred to a ‘consultation’ for depression as extending across a series of meetings, giving time for a range of issues and problems to be discussed. Patients, on the other hand, tended to approach each consultation as a discrete episode, or at least confronted the uncertainties and problems associated with seeking medical help anew each time they considered the decision to consult. The contrast between the lay and professional experience of consultation time is a striking finding of the research. It points to the need for GPs to be more aware of patient anxieties in this regard, and to devise effective means of raising patients’ sense of time entitlement in general practice consultations.25
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Conclusion |
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In contrast to the widely voiced concern that time restrictions undermine GPs’ capacity to diagnose and treat depression effectively, the doctors in this study tended to be quite relaxed about consultation time. This was due to their confidence in antidepressants as an effective treatment for depression as well as their skills in providing counselling support, and also their capacity to utilize time flexibly in allocating variable consultation lengths to patients according to specific need. Initial consultations for depression, in particular, took considerably longer than the normal appointment time. However, once the initial work of diagnosis and treatment had been undertaken, follow-up visits often could be accommodated within standard booking slots. Although the GPs that were interviewed felt that it would be satisfying to have more time to spend with patients, current constraints did not preclude effective (albeit pragmatic) management and treatment of depressed patients. Depression was viewed as a relatively straightforward problem for which effective treatment was available, and which usually could be managed with the resources available to general practice. The GPs’ equanimity contrasts with the markedly greater concern of patients, whose anxiety about perceived lack of time inhibited their felt capacity to benefit fully from the consultation.
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Acknowledgments |
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We are grateful to the doctors who took part in this research. This work forms part of a larger project supported by the Concordance Research Fellowship which is funded as part of the Department of Health’s Policy Research Programme and administered by the Royal Pharmaceutical Society of Great Britain.
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References |
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