ObjectiveTo describe the average primary care physician consultation length in economically developed and low-income/middle-income countries, and to examine the relationship between consultation length and organisational-level economic, and health outcomes.Design and outcome measuresThis is a systematic review of published and grey literature in English, Chinese, Japanese, Spanish, Portuguese and Russian languages from 1946 to 2016, for articles reporting on primary care physician consultation lengths. Data were extracted and analysed for quality, and linear regression models were constructed to examine the relationship between consultation length and health service outcomes.ResultsOne hundred and seventy nine studies were identified from 111 publications covering 28 570 712 consultations in 67 countries. Average consultation length differed across the world, ranging from 48 s in Bangladesh to 22.5 min in Sweden. We found that 18 countries representing about 50% of the global population spend 5 min or less with their primary care physicians. We also found significant associations between consultation length and healthcare spending per capita, admissions to hospital with ambulatory sensitive conditions such as diabetes, primary care physician density, physician efficiency and physician satisfaction.ConclusionThere are international variations in consultation length, and it is concerning that a large proportion of the global population have only a few minutes with their primary care physicians. Such a short consultation length is likely to adversely affect patient healthcare and physician workload and stress.

The Hawthorne studies in the 1930s demonstrated how difficult it is to understand workplace behaviour, and this includes professional performance. Studies of interventions to improve professional performance, such as audit, can provide useful information for those considering using such methods, but cannot replace judgement. In particular, there is no single phenomenon that can be labelled 'the Hawthorne effect'. The process of triangulation, considering a subject from different perspectives, might overcome the problems of Hawthorne effects better than using a single method such as controlled trials.

The test and retest opportunity afforded by reviewing a patient over time substantially increases the total gain in certainty when making a diagnosis in low-prevalence settings (the time-efficiency principle). This approach safely and efficiently reduces the number of patients who need to be formally tested in order to make a correct diagnosis for a person. Time, in terms of observed disease trajectory, provides a vital mechanism for achieving this task. It remains the best strategy for delivering near-optimal diagnoses in low-prevalence settings and should be used to its full advantage.

Benzodiazepines are still widely prescribed in general practice, despite repeated warnings about the problems associated with their use. Other studies have shown that a variety of interventions can reduce prescribing, but these have been restricted to relatively few general practices or patients. We co-ordinated an audit of benzodiazepine prescribing and withdrawal in 15 practices caring for 87,900 patients across a district. In total 3234 patients (37 per 1000 registered patients) were discovered to be taking the drugs at the start of the programme, and 16% of these people stopped taking the drugs by the conclusion of the audit 8 months later. There was no relation between success at benzodiazepine cessation and initial levels of prescribing, nor with practice size. Younger patients were significantly more likely to stop benzodiazepines than those over the age of 65.

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