COUNTING the number of consultations in general practices (Letters, July 7), provides a crude measure of activity, but says nothing about the length or content of consultations.

Earlier this week, I shadowed a GP working in one of Glasgow's most deprived areas. She arrived early at 7.20 am to deal with 38 items of correspondence, all requiring to be checked, and prescriptions altered, a patient phoned or arrange­ments made, before the day "started".

As the on-call doctor, on a busier day than usual, she did seven house visits that morning, each taking 30 minutes. It took an hour to enter all the details back in the practice and make necessary arrangements. She had five minutes for lunch. A colleague who took over the on-call did three more home visits and dealt with 22 telephone consultations and six emergency appointments.

The afternoon surgery ran for three hours, and would have lasted another hour if all the booked patients had attended. The problems addressed included cancer, depression, agoraphobia, asthma, self-harm, bereavement, domestic violence, heart failure, alcohol abuse, dementia, social neglect and so on, often in combination. She left for home after a 12-hour day, with the 61 items of correspondence still to deal with.

I didn't see any short or trivial consultations. There were no "worried well" patients, but a worried doctor, who left no loose ends, in dealing with a series of complicated patients, all of whom she knew well. One patient said Dr xxx "is the only person I can relate to". Another came in grim-faced, avoiding eye contact, almost in tears, but left 15 minutes later, beaming a smile.

I was struck by the intensity of the day, every patient getting the same attention. Doctors who do this in very deprived areas earn less than most GPs. They have more complicated patients. They work long hours. None of this is captured by counting consultations.

Graham Watt,

Professor of General Practice,

University of Glasgow.