Table 1 Definition of the stages of consultation
The Greater consultation: We understood this to be the whole consultation beginning when the GP selects the patient from the appointment list and ending when that GP closes the electronic health record after the patient has left. We did not include further work on the record if the clinician returned to the record later in the same recording session. The length of the ‘greater consultation’ for the GP is usually the time elapsed from opening to closing the patient record (see below for a caveat to this rule).
Patient consultation: For the patient, we interpreted the consultation time to start when they are welcomed by the GP into the consulting room to the time they leave.
Pre-patient consultation: For the GP, this is the time they allocate to preliminary tasks after selecting the patient from the appointment list before welcoming the patient; we also refer to this as preparation.
Post-patient consultation: For the GP, this is the time they allocate to tasks associated with the patient after the patient has left.
Typically, the ‘patient consultation’ occurs within the time for accessing the patient record (the ‘greater consultation’), but there were occasional instances where patient consultation begins before the clinician opens the record or where the record is closed before the patient leaves. In these circumstances, the ‘greater consultation’ starts or finishes with the arrival or departure of the patient.
Within the patient consultation, we conveniently derived five overarching stages from the Roter Interaction Analysis System analysis:
  1. opening;

  2. history taking;

  3. examination;

  4. counselling/directing the patient;

  5. closing.

These typically followed the above order, but (ii), (iii) and (iv) could occur more than once in a consultation.