Patients' perceptions of entitlement to time in general practice consultations for depression: qualitative study

Objective: To investigate patients' perceptions of entitlement to time in general practice consultations for depression. Design: Qualitative study based on interviews with patients with mild to moderate depression. Setting: Eight general practices in the West Midlands and the regional membership of the Depression Alliance. Participants: 32 general practice patients and 30 respondents from the Depression Alliance. Results: An intense sense of time pressure and a self imposed rationing of time in consultations were key concerns among the interviewees. Anxiety about time affected patients' freedom to talk about their problems. Patients took upon themselves part of the. responsibility for managing time in the consultation to relieve the burden they perceived their doctors to be working under. Respondents' accounts often showed a mismatch between their own sense of time. entitlement and the doctors' capacity to respond flexibly and constructively in offering extended consultation time when this was necessary. Patients valued time to talk and would often have liked more, but they did not necessarily associate length of consultation with quality. The impression doctors gave in handling time in consultations sent strong messages about legitimising the patients' illness and their decision to consult. Conclusions: Patients' self imposed restraint in Liking up doctors' time has important consequences for the recognition and treatment of depression. Doctors need to have a greater awareness of patients' anxieties about time and should move to allay such anxieties by pre-emptive reassurance and reinforcing patients' sense of entitlement to time. Far from acting as consumers patients voluntarily assume responsibility for conserving scarce resources in a health service that they regard as a collective rather than a personal resource.