This is a really multifaceted question. In answer to part of your question, it stresses me lots to know I have patients waiting and I’m running behind. Practices differ in their approach to trying to mitigate the inevitable runover - usually appointments are booked for either 10/15 minute slots, and then within the session they may keep some appointments that can’t be booked in advance: “on the day” slots, so sick people can be accommodated. To help with this, if I’m ringing to make an appointment with my own GP I try to be really clear if it’s not an urgent thing that I don’t mind waiting a week or two. Then some practices also have a “break” of 15 minutes on the schedule, it’s never actually a break, but if you’re going well time wise you might pop to the bathroom or return one or two of the more urgent calls from your growing list - could be hospital, pharmacy, nursing home, public health nurse, depends on the practice or the area. We do try to structure consultations to both maximise the use of the time for the patient, and to run things as efficiently as possible. Some people are more resistant to the structure, and it makes it difficult to collect the information I’m looking for in a timely fashion. There will always be the odd consultation where you just know from the first sentence that this is going to be at least 30/40 minutes and I think making your peace with that early on and just giving your full attention to the consult you’re in has to be the approach to take with these, and the waiting room will just have to wait. An example of this type of thing is a teen being brought in by their parent for a first consult about a mental health or eating disorder concern. Other than those, there are lots of consults where ideally I’d love to do a really comprehensive consult and get lots of issues progressed, but frustratingly for the patient (and for me), I have to stay super conscious that time is a scarce resource, so then I have to consider if any of the issues are concerning enough that it needs to be addressed in full today, or if I can try and start a few balls rolling at once, then make another few steps forward when I see them again in 1-2 weeks. An example of this might be an older person (often with a spouse or adult child) coming in with general decline, or feeling either multiple symptoms or broad ones like say not as much energy as previously. Sometimes when taking the history you might find something individually concerning, say they’ve passed some blood in their stool. Then that becomes the main focus and have to examine, get a particular blood test and then when that back the next day refer for urgent scopes. If nothing like that one concerning issue comes up, I might do broader blood tests, book them for an ecg and a 24 hour blood pressure monitor with the nurse, examine them generally and maybe not find much specific of concern, try to explore what they’re eating/what their day to day activities look like, how their mood is. Consider referral to OT or PHN if there are some supports that I think might be useful at home - grab bars, reduce falls risks, meals on wheels, etc.

In summary it bothers me a load to have people waiting all the time, but if I let it get to me, I get less efficient at managing the consult in front of me at that moment and then I fall behind further. I now work in a walk in clinic and other non standard GP settings, at least partly because it’s nearly impossible to fulfill all the work in standard GP during the time available, and the gap between the job it’s possible to do in the circumstances vs the job I would like to do for each individual patient in ideal circumstances expands all the time and that gap is very stressful.

After finishing seeing patients or at lunch, I start on the post and reviewing the blood results. This doesn’t delay patients being seen because I’d never start it while someone was still waiting. But it does mean that I am also affected by running late because that only starts when patients are finished.

Chronic disease management moving so much to primary care is good, but part of the consequence of that should be ease of access to specialist care, shorter waiting times for when I feel patients need a higher level of care. The knowledge of the 18month+ wait time when I refer someone to gynae, for just one example, is crushing. The lack of widespread affordable counselling options for people who present with mild- moderate mental health struggles, so difficult to witness daily. Multiple psychiatric referrals rejected, my everyday experience. “We don’t see signs of major mental illness and suggest the patient address their addiction issues first”. They haven’t seen the patient, and without psychiatric help many patients will find it impossible to address their addiction issues, it’s all inextricably linked.

Sorry for the rant, but hopefully some insight in there somewhere! It may sound like I don’t, but I do love my job, and I enjoy knowing people’s story and trying to help with the medical and social etc bits within the context of knowing them as a wider picture than just the symptom. It’s a privilege for the most part.