Appointment scheduling and clinic session pressures
diabetes
MINOR, DIABETES
Both polyclinics scheduled all CSP conversations for two specific weekdays, but routine consultations, including walk-in appointments, were also allocated to these clinic sessions. Some participants found the intermittency of CSP conversations within clinic sessions challenging because they needed to keep switching gears for the change from “usual” consultations.The workload pressure generated by long patient queues was a strong theme in all interviews. In principle, more time was allocated for CSP conversations (fewer appointments were allocated to clinic sessions with CSPs). In practice, however, participants were often uncomfortably aware that their teamlet partner would be struggling with a long patient queue while they took 20-30 minutes for a CSP conversation – and they would also return to face the queue. All participants admitted at least minor shortfalls from what they understood to be good enactments of a CSP conversation when feeling this pressure. This was well summed up by HP Boon’s reflection that “We may short-change our CSP patients to a certain extent” (w1), but the shortfalls apparently varied in the extent to which they undermined the values and ethos of CSP. When keeping an eye on the patient queue resulted in sometimes rushing a bit, being less fully empathetic, or not working through the steps of goal setting and action planning with patients with well-controlled diabetes and no significant concerns, the shortfalls were arguably less significant than more routinely “cutting short” what patients were saying and “reverting back” to usual consults along the lines of telling patients what to do and being summarily dismissive of those not ready to act on their diabetes as health professionals would prefer.