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Cited by 515Patient-Provider Communication in HealthcarePrimary Care and Health OutcomesHealthcare Systems and Technology

Consultation length in general practice: cross sectional study in six European countries

Open access
Deveugele, Myriam, Derese, Anselm, van den Brink-Muinen, Atie, Bensing, Jozien, De Maeseneer, Jan·2002·BMJ
DOI 10.1136/bmj.325.7362.472PMC PMC119444
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Abstract

Objectives : To compare determinants of consultation length discussed in the literature with those found in consultations with general practitioners from different European countries; to explore the determinants of consultation length, particularly the effect of doctors' and patients' perceptions of psychosocial aspects. Design : Analysis of videotaped consultations of general practitioners from the Eurocommunication study and of questionnaires completed by doctors and by patients. Setting : General practices in six European countries. Participants : 190 general practitioners and 3674 patients. Results : In a multilevel analysis with three levels (country, general practitioner, and patient), country and doctor variables contributed a similar amount to the total variance in consultation length (23% and 22%, respectively) and patient variables accounted for 55% of the variance. The variables used in the multilevel analysis explained 25% of the total variation. The country in which the doctor practised, combined with the doctors' variables, was as important for the variance in consultation length as the variation between patients. Consultations in which psychosocial problems were considered important by the doctor and the patient lasted longer than consultations about biomedical problems only. The doctor's perception had more influence in this situation than the patient's. Consultation length is influenced by the patients' sex (women got longer consultations), whether the practice was urban or rural, the number of new problems discussed in the consultation (the more problems the longer the consultation), and the patient's age (the older the patient the longer the consultation). As a doctor's workload increased, the length of consultations decreased. The general practitioner's sex or age and patient's level of education were not related to the length of consultation. Conclusion : Consultation length is determined by variables related to the doctor and the doctor's country as well as by those related to patients. Women consulting in an urban practice with problems perceived as psychosocial have longer consultations than other patients.

AI snapshot

Written from the paper’s full text.

TL;DR

Consultation length in six European countries varied substantially and was shaped by country, doctor, and patient factors, with patient-level variables accounting for 55% of total variance and country and doctor variables about 22–23% each. Consultations were longest for women in urban practices when psychosocial problems were perceived as important, especially by the doctor.

Key findings

  • Mean consultation length overall was 10.7 (SD 6.7) minutes. Belgium (15.0 min) and Switzerland (15.6 min) had the longest consultations; Germany (7.6 min) and Spain (7.8 min) had the shortest; the Netherlands (10.2 min) and United Kingdom (9.4 min) were intermediate.
  • In multilevel analysis, total variance in consultation length was 44.2, split into 24.4 (55%) at patient level, 9.8 (22%) at doctor level, and 10.0 (23%) at country level; the variables used explained 25% of total variation (R²=0.252).
  • Consultations were longer in city practices by 1.5 minutes, for women patients by about 1 minute, for at least one new problem by 51 seconds, when the doctor perceived psychosocial problems as important by 50 seconds, when the patient perceived psychosocial aspects as important by 30 seconds, and when the GP diagnosed a psychosocial problem by 0.95 minutes.
  • Consultation time increased by about 1 second per year of patient age and decreased by 0.6 seconds per additional weekly workload unit; GP sex or age, patient education, and prescribing behaviour were not significantly related to consultation length.

Methods

  • Cross-sectional analysis of videotaped general practice consultations from the Eurocommunication study in six European countries, with questionnaires completed by doctors and patients.
  • Participants were 190 general practitioners and 3674 patients; 20 consultations were videotaped per doctor and 15 per doctor were analysed. Consultation length was measured with a stopwatch, subtracting interruptions.
  • Multilevel regression analysis with three levels (country, general practitioner, patient) using MLwiN 1.1; principal components analysis with Varimax rotation was used on patient questionnaire items, and SPSS 9.0 was used for data analysis.

Limitations

  • The paper states that the general practitioner groups were not representative: they had lower workloads than doctors in the task profile study, more urban practices were included, and more women doctors took part.
  • The paper states that all doctors agreed to have consultations videotaped, so they may have been more interested in communication and more experienced with research/training than average doctors, potentially biasing findings.
  • The paper notes that only six countries were included, so country-level variation is subject to a large standard error; the text also makes evident that 976 of 4650 patients (21%) refused participation, with more women refusing and some problem types refusing more often, though age and education were similar between participants and refusers.

Model-written summary. Check it against the paper before relying on it.

Integrity signals

Registry

Crossref · 10.1136/bmj.325.7362.472

Cites

24 of 24 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Claims the paper makes

2 of 23 cited sources checked · 0 supported · 0 flagged · accuracy not yet measured

  • Findingown data

    When the doctor perceived a psychosocial problem, the increase in consultation time was nearly twice as long as that when the patient perceived a psychosocial problem.

    “When the doctor perceived a psychosocial problem, the increase in consultation time was nearly twice as long as that when the patient perceived a psychosocial problem.”
    Quote in the paperSubstantial claim
  • Findingown data

    Consultations were longer when the patient felt that psychosocial problems were important (by 30 seconds) than when they did not.

    “Consultations were longer when the doctor or patient felt that psychosocial problems were important (by 50 seconds for the doctor's perception and 30 seconds for the patient's perception) than when they did not.”
    Quote in the paperSubstantial claim
  • Findingown data

    The length of consultation was not significantly longer for consultations in which psychosocial aspects were given as a reason for the encounter by the patient.

    “The length of consultation was not significantly longer for consultations in which psychosocial aspects were given as a reason for the encounter by the patient.”
    Quote in the paperSubstantial claim
  • Findingown data

    Consultations in city practices lasted 1.5 minutes longer than those in rural practices.

    “Consultations in city practices lasted 1.5 minutes longer than those in rural practices”
    • Also stated in: § Other determinants · plain
      “Consultations lasted longer in city based practices than in rural practices.”
    Quote in the paperSubstantial claim
  • Findingown data

    Consultations with women patients lasted about 1 minute longer than those with men.

    “those with women patients lasted about 1 minute longer than those with men”
    • Also stated in: § Other determinants · plain
      “Consultation times were longer for women patients than for men.”
    Quote in the paperNot a substantial claim
  • Classified as probably not a substantial claim. 11
  • May combine two claims. 22

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Doctors spend more time with patients who have new problems than those with already discussed problems.

    “Doctors spend more time with patients who have new problems than those with already discussed problems.”
    Quote in the paperNot a substantial claim2 of 2 sources checked
    • cites [8] Morell, 1986, The “five minute” consultation: effect of time constraint on clinical content and patient satisfaction., BMJ source

      The Introduction (p. 1) says that whether a consultation concerns a new problem or is a follow-up can affect its duration. It does not say that doctors spend more time on new problems than on previously discussed ones; the reported time comparisons concern appointment-booking intervals instead. (LLM, conf=0.77)

      Experimental — accuracy not yet measured
    • cites [9] Morell, 1987, How can good GP care be achieved?, BMJ source

      The Introduction discusses immediate and continuing problems, and the ‘How many patients can a general practitioner look after?’ section discusses consultation duration. Neither compares time spent with patients presenting new problems against time spent on previously discussed problems. Searches for that comparison and for follow-up consultation duration found no supporting passage in our copy. (LLM, conf=0.76)

      Experimental — accuracy not yet measured

  • May combine two claims.

    Findingown data

    The six countries could be divided into three pairs that differed significantly from each other with respect to total consultation time: Belgium and Switzerland had the longest consultation times, Germany and Spain had the shortest, and the Netherlands and the United Kingdom were in between.

    “The six countries could be divided into three pairs that differed significantly from each other with respect to total consultation time.Belgium and Switzerland had the longest consultation times, Germany and Spain had the shortest consultation times, and consultation times for the Netherlands and the United Kingdom were in between.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    The presence of psychosocial problems in a consultation was related to the consultation's duration only when a psychosocial problem was diagnosed by the general practitioner, but not when it was mentioned by the patient as a reason for the consultation.

    “The presence of psychosocial problems in a consultation was related to the consultation's duration only when a psychosocial problem was diagnosed by the general practitioner, but not when it was mentioned by the patient as a reason for the consultation.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    As the patient's age increased by one year, the consultation time increased by one second.

    “As the patient's age increased by one year, the consultation time increased by one second.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    For Belgium, the United Kingdom, the Netherlands, and Switzerland, the length of consultation in this study did not differ significantly from that in other studies from that country.

    “For four countries (Belgium, the United Kingdom, the Netherlands, and Switzerland), we compared our results with those from other studies in which consultation times were measured; for no country did the length of consultation in our study differ significantly from that in other studies from that country.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    The total variance in consultation length was 44.2, split into 24.4 (55%) at the patient level, 9.8 (22%) at the doctor level, and 10.0 (23%) at the country level.

    “The total variance in consultation length was 44.2.Multilevel analysis showed that this variance split into 24.4 (55%) at the patient level, 9.8 (22%) at the doctor level, and 10.0 (23%) at the country level.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    When doctors perceived a psychosocial problem, the duration of the consultation increased; this was as true when the doctor thought that a psychosocial element was important, even if it was not mentioned during the consultation, as when he or she made a psychosocial diagnosis.

    “When doctors perceived a psychosocial problem, the duration of the consultation increased; this was as true when the doctor thought that a psychosocial element was important, even if it was not mentioned in during the consultation, as when he or she made a psychosocial diagnosis.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    Length of consultation was not significantly correlated with the educational level of the patient, the patient's sex or age, or the experience or prescribing behaviour of the doctor.

    “Length of consultation was not significantly correlated with the educational level of the patient, the patient's sex or age, or the experience or prescribing behaviour of the doctor (table 5).”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    The consultation time decreased as the doctor's workload increased-the consultation time reduced by 0.6 seconds for every additional unit of workload in a week.

    “The consultation time decreased as the doctor's workload increased-the consultation time reduced by 0.6 seconds for every additional unit of workload in a week.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    Workload had a negative influence on consultation time, but this relation was weak when calculated as seconds.

    “Workload had a negative influence on consultation time, but this relation was weak when calculated as seconds.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Of doctors' characteristics reported as important in the literature, our study confirmed only the positive orientation to psychosocial problems; the age and sex of the doctor had no impact on the duration of the consultation.

    “Of doctors' characteristics reported as important in the literature, our study confirmed only the positive orientation to psychosocial problems; the age and sex of the doctor had no impact on the duration of the consultation.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    Age seemed to influence the length of consultation, but its influence was too small to take into account-doctors spent about 1.2 seconds more time with patients for every year increase in the patients' age.

    “Age seemed to influence the length of consultation, but its influence was too small to take into account-doctors spent about 1.2 seconds more time with patients for every year increase in the patients' age.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    The patient's age and social class are determinants of consultation length-the older the patient or the higher their social class, the longer the consultation.

    “The patient's age and social class are determinants of consultation length-the older the patient or the higher their social class, the longer the consultation.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [2] Buchnan IC Richardson IM .Time study of consultations in general practice. In: Scottish health services statistics, no 27. Edinburgh:Scottish Home and Health Department,1973.

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    The size of a doctor's list is not an important determinant of consultation length, except when lists are extremely large or extremely small.

    “The size of a doctor's list is not an important determinant of consultation length, except when lists are extremely large or extremely small.”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [6] Butler J Calnan M .Too many patients? A study of the economy of time and standards of care in general practice. Aldershot:Avebury,1987. source
    • cites [7] Knight, 1987, The importance of list size and consultation length as factors in general practice., J R Coll Gen Pract

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Doctors are less likely to prescribe during long consultations.

    “Doctors are less likely to prescribe during long consultations.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [12] Hughes, 1983, Consultation length and outcome in two group general practices., J R Coll Gen Pract

  • Classified as probably not a substantial claim.

    Study design and conductnone given

    A sample size of a minimum of 27 general practitioners in each country and 15 patients for each general practitioner was needed to detect an effect size of 0.30 at a significance level of 0.05 with a power of 0.80.

    “A sample size of a minimum of 27 general practitioners in each country and 15 patients for each general practitioner was needed to detect an effect size of 0.30 at a significance level of 0.05 with a power of 0.80.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Premisecitation

    Important differences in consultation length exist between countries because of differences in the structure of healthcare organisations and the role of general practitioners.

    “Important differences in consultation length exist between countries because of differences in the structure of healthcare organisations and the role of general practitioners.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [1] Wilson, 1991, Consultation length in general practice: a review., Br J Gen Pract

  • May combine two claims.

    Premisecitation

    Older doctors, women doctors, and doctors with positive attitudes to mental health problems tend to have longer consultations.

    “Older doctors, women doctors, and doctors with positive attitudes to mental health problems tend to have longer consultations.”
    Quote in the paperNot a substantial claim0 of 3 sources checked
    • cites [2] Buchnan IC Richardson IM .Time study of consultations in general practice. In: Scottish health services statistics, no 27. Edinburgh:Scottish Home and Health Department,1973.

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

    • cites [3] Gray, 1982, The effect of the doctor's sex on the doctor patient relationship., J R Coll Gen Pract
    • cites [4] Whitehous, 1987, A survey of the management of psychosocial illness in general practice in Manchester., J R Coll Gen Pract

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • May combine two claims.

    Interpretationown data

    The presence of psychosocial problems in the consultation was an important factor influencing the length of consultation, and doctors' and patients' perceptions about psychosocial problems affected the length of the consultation.

    “The presence of psychosocial problems in the consultation was an important factor influencing the length of consultation, and doctors' and patients' perceptions about psychosocial problems affected the length of the consultation.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Study design and conductown data

    The factor analysis of patients' questionnaires produced two subscales-a biomedical scale with six items and a psychosocial scale with four items-with Cronbach's alpha 0.84 for the biomedical scale and 0.83 for the psychosocial scale.

    “This analysis produced two subscales-a biomedical scale with six items and a psychosocial scale with four items (table 3).Cronbach's was 0.84 for the biomedical scale and 0.83 for the psychosocial scale.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    Stopwatches accurately measure the length of consultations, and videotaping is accurate and valid and does not alter doctors' behaviour in consultations.

    “Stopwatches accurately measure the length of consultations, and videotaping is accurate and valid and does not alter doctors' behaviour in consultations.”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [1] Wilson, 1991, Consultation length in general practice: a review., Br J Gen Pract
    • cites [13] Pringle, 1990, Does the awareness of being video recorded affect doctors' consultation behaviour?, Br J Gen Pract

  • May combine two claims.

    Interpretationown data

    The country in which general practitioners work and the individual variation between general practitioners seem to be important determinants of the length of consultations.

    “The country in which general practitioners work and the individual variation between general practitioners seem to be important determinants of the length of consultations.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Study design and conductnone given

    Our general practitioners had lower workloads than the average doctor in the same country in the task profile study, there was a higher proportion of urban practices in our study, and more women doctors took part.

    “Our general practitioners had lower workloads than the average doctor in the same country in the task profile study, there was a higher proportion of urban practices in our study, and more women doctors took part.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    A previous study showed that women doctors had longer consultations than men doctors.

    “This contradicted a previous study, which showed that women doctors had longer consultations than men doctors.23”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [23] Roter, 1991, Sex differences in patients' and physicians' communication during primary care visits., Med Care source

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductreasoning

    All of the doctors in our study agreed to have their consultations videotaped; this may mean that they were more interested in communication and had more experience with research and training than the average doctor, and this positive attitude towards communication could have biased our findings.

    “All of the doctors in our study agreed to have their consultations videotaped.This may mean that they were more interested in communication and had more experience with research and training than the average doctor.This positive attitude towards communication could have biased our findings.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S2 (checkable), S4 (based).

    Interpretationnone given

    Studies based on observations of real encounters contradict, or at least tone down, conclusions from other types of research.

    “Studies based on observations of real encounters contradict, or at least tone down, conclusions from other types of research.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationreasoning

    For new problems the doctor needs to explore the problem, but for follow up consultations the doctor can rely on information from earlier encounters.

    “For new problems the doctor needs to explore the problem, but for follow up consultations the doctor can rely on information from earlier encounters.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Several studies reported an influence of social class on consultation length.

    “This contradicts results from several studies that reported an influence of social class on consultation length.”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [1] Wilson, 1991, Consultation length in general practice: a review., Br J Gen Pract
    • cites [2] Buchnan IC Richardson IM .Time study of consultations in general practice. In: Scottish health services statistics, no 27. Edinburgh:Scottish Home and Health Department,1973.

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • May combine two claims.

    Study design and conductown data

    Although the patients in our study probably were representative of the population of the participating countries, the groups of general practitioners were not.

    “Although the patients in our study probably were representative of the population of the participating countries, the groups of general practitioners were not.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    Women patients are often described as more talkative than men, and they are more likely to discuss psychosocial problems.

    “Women patients are often described as more talkative than men, and they are more likely to discuss psychosocial problems.23”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [23] Roter, 1991, Sex differences in patients' and physicians' communication during primary care visits., Med Care source
30 of 30

  • The paper relies on this without support.

    General practitioners in Belgium and Switzerland are paid mostly by direct payment from the patient at the end of the consultation.

    “Moreover, general practitioners in Belgium and Switzerland are paid mostly by direct payment from the patient at the end of the consultation.”

  • The paper relies on this without support.

    The United Kingdom and the Netherlands have well organised primary healthcare systems, with restricted patient lists and gatekeeping.

    “The United Kingdom and the Netherlands, which had intermediate consultation times, have well organised primary healthcare systems, with restricted patient lists and gatekeeping.”

  • The paper relies on this without support.

    General practitioners in the United Kingdom and the Netherlands are predominantly paid by capitation.

    “General practitioners in these countries are predominantly paid by capitation (the government supplies a fee per patient).”

  • The paper relies on this without support.

    In urban practices, patients presented more problems within one consultation.

    “In urban practices, patients presented more problems within one consultation.”
4 of 4

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

Each contradiction between two passages listed here was confirmed by an independent check.

  • Overall doctor sex ratio conflicts with the doctor counts

    Minor

    Table 2 gives the overall men:women ratio as 76:34, whereas table 1 counts 127 men and 63 women among 190 doctors-approximately 67:33.

  • Patient sex and age are reported as both significant and not significant

    Minor

    The results say consultation length was not significantly correlated with patient sex or age, but table 5 reports positive coefficients for both, with 95% confidence intervals that exclude zero. The paper also describes longer consultations for women and older patients.

2 of 2

Cites

Flagged first, then by citations

Research works printed but not linked: 1

  1. Murray, 1978, Consulting time and prescribing rates., Update, 16, 969

Cited by

Sorted by citations

Related

Authors
Deveugele, M., Derese, A., van den Brink-Muinen, A., Bensing, J., & De Maeseneer, J.
Affiliations
Ghent University (BE)
Corresponding author
Deveugele, Myriam
ORCID
Deveugele, Myriam
Venue
BMJ
Publisher
BMJ
Published
2002-08-31
Volume
325
Issue
7362
Pages
472.1
ISSN
  • 0007-1447 (ISSN-L)
  • 0959-8138
  • 1468-5833
DOI
10.1136/bmj.325.7362.472
PMC
PMC119444
OpenAlex
W2124095734
Semantic Scholar
2119cffb00ce6639f398f137dd296833fd1f4fe7
Cited by
515
References
23
Citations by year
2026: 12 · 2025: 19 · 2024: 19 · 2023: 20 · 2022: 23 · 2021: 18 · 2020: 18 · 2019: 15 · 2018: 24 · 2017: 25 · 2016: 24 · 2015: 26 · 2014: 27 · 2013: 27 · 2012: 27
FWCI
27.66
Type
journal article
Language
en
Open access
Licence
www.bmj.com/company/legal-information/terms-conditions/legal-information/tdm-licencepolicy (tdm)
Locations
  • BMJ (publishedVersion)
  • PubMed (publishedVersion)
  • Europe PMC (PubMed Central) (submittedVersion)
  • PubMed Central (submittedVersion)
  • Ghent University Academic Bibliography (Ghent University) (submittedVersion)
  • Utrecht University Repository (Utrecht University) (submittedVersion, other-oa)
Topics
  • Health Sciences › Health Professions › General Health Professions › Patient-Provider Communication in Healthcare
  • Health Sciences › Health Professions › General Health Professions › Primary Care and Health Outcomes
  • Social Sciences › Business, Management and Accounting › Organizational Behavior and Human Resource Management › Healthcare Systems and Technology
Keywords
consultation time, general practice, general practitioners, patient sex, psychosocial problems, physician workload, patient age, patient education level, cross-national comparison, doctor-patient interaction
MeSH terms
Adult, Age Factors, Appointments and Schedules, Cross-Sectional Studies, Europe, Factor Analysis, Statistical, Family Practice, Female, Humans, Male, Middle Aged, Office Visits, Physician-Patient Relations, Professional Practice, Surveys and Questionnaires, Rural Health, Time and Motion Studies, Urban Health, Patient Satisfaction

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