The pattern of silent time in the clinical consultation: an observational multichannel video study

To describe silent time in the clinical consultation: who initiates and terminates it and at what stage most silence occurs. We conducted an analysis of 127 multichannel video recordings of consultations by 12 GPs; filmed using the ALFA (Aggregation of Log Files for Analysis) open-source toolkit. The start and end of silence was manually coded using an observational data capture tool. We report who initiates and terminates silence, describe the proportion of the consultation, what happens within it and the distribution of silent periods by quartile of the consultation. We found the median proportion of silence was 12.3% and interquartile range 14.3%. Silent periods (52.4%) were both initiated and terminated by the doctor. The majority of silent time (78.1%) is spent on computer-based activities and physical examination. Silent periods which do not involve physical examination mainly occur in the second half of the consultation and represent 70.6% of the total duration and 64.8% of the episodes of silence. The computer is a third party in the GP consultation and often requires silent time during doctor-computer interaction. Doctors' control and patients allow silence for the doctor to complete tasks often involving the computer and also for time out from the consultation. There is a clear pattern of when doctors need most to have silence and consultation models should be developed that reflect this need.