The impact of remote consultations on brief conversations in general practice

Abstract

Background The consultation between the family doctor and patient is the cornerstone of general practice, supporting relationship-based care and continuity: which can improve patient outcomes.1,2 It enables rapport to be established and provides a setting to begin conversations on sensitive topics such as weight management in a patient with osteoarthritis, or alcohol consumption in someone with elevated liver function tests. Brief conversations in general practice are introductory enquiries or exchanges that are initiated by the GP, often as a stepping stone to more detailed discussions, to improve patient’s capability to make positive changes for their health and wellbeing. Dealing with and managing the patient’s presenting complaint is important, but using the opportunity to explore aspects of health promotion, prevention, and behaviour change is key to realising the exceptional potential of the primary care consultation.3 Leaning on the Making Every Contact Count public health initiative, GPs can use consultations to initiate brief conversations, which in turn can lead to the delivery of interventions and potentially result in long-lasting benefits for patients and the NHS.4,5 In a consultation with someone who is experiencing distress GPs who utilise an open questioning style and sensitively ask about self-harm can facilitate further discussion about self-harm and suicide: this can be life-saving.6 In the management of obesity, language is important and seeking the permission of the patient — ‘Would you mind if we spoke about your weight?’, for example — provides a chance for patients to share concerns or ask questions.7 Patients perceive receiving a brief health behaviour change intervention as appropriate and helpful, especially in long term conditions, with the doctor-patient relationship the foundation of the conversation.8 In this commentary we discuss how the increased reliance on remote consulting, exacerbated by COVID-19, may impact on the opportunity for brief conversations in general practice globally, and outline implications for clinical practice and policy, and suggestions for future research.