Why our first visits are 45 minutes — and why most clinics don't

The average Pakistani private-clinic consultation is **7 minutes**, sometimes less. In a busy GP setting, 90 patients across a 10-hour day, that math is the only way the numbers work. We deliberately don't try to match that math. First visits in this practice are 45 minutes. Here's what gets done in those minutes — and why those minutes save you money downstream.

Minutes 1–12 — the history

A full medical history takes time. The opening question is not "what's wrong" — it's "tell me what's going on, in your own words." The patient talks. We listen. We do not interrupt for the first two minutes.

Then we ask:

• When did this start? Did anything specific bring it on?
• How has it changed over time — better, worse, the same?
• What does it stop you from doing?
• What have you already tried — medications, lifestyle changes, alternative remedies?
• What are you most worried it might be?

That last question is the most useful one in medicine. Patients often arrive with a specific fear — *"my father had a heart attack at 50 and I think I'm having one too"* — and that fear shapes how they describe symptoms. Surfacing it in minute 8 means we can address it directly in minute 38.

We also ask about: past medical history, current medications (please bring the box or a list, not "the white tablet"), drug allergies, surgical history, family history, social history (work, sleep, exercise, smoking, alcohol, diet).

Minutes 12–22 — the examination

A focused examination based on the history. For a fatigue presentation: pulse, blood pressure both arms, pallor check, neck examination, thyroid palpation, abdomen, brief neurological screen. For chest pain: cardiac and respiratory exam, peripheral pulses, calf check for DVT. For headache: blood pressure, eye exam, basic cranial nerve screen, neck examination, gait check.

Examination is not skippable. A history alone can mislead. An examination plus history is more accurate than either alone. Also, patients feel different after being examined properly — there is a reassurance quality to careful hands-on examination that no investigation replaces.

Minutes 22–32 — the explanation

We explain what we think is going on. In plain English (or Urdu where the patient prefers). With drawings if needed. We name the diagnosis or list the two or three most likely differentials. We explain what each one is, how we'd confirm it, and what the treatment looks like.

If we're not sure, we say so. If we need investigations to narrow down, we explain *which* investigation and *why* — not a shotgun panel. If we think this is something that resolves on its own, we say that too. Pakistani medicine over-prescribes; we don't believe in writing five medications when one will do, or sometimes none.

Minutes 32–42 — the plan

A written plan. Always. Even if it's three lines.

• Medications: name, dose, timing, duration. If insurance is involved, we note generic alternatives.
• Lifestyle: specific, not generic. Not "exercise more" — "walk 20 minutes after dinner, five days a week, starting this Sunday."
• Investigations: which, where (we suggest specific labs we trust), when.
• Follow-up: when, in what format. Most plans include one no-cost WhatsApp follow-up at the 7-day mark.

Minutes 42–45 — questions

The patient gets the floor. Anything they didn't ask earlier. Anything that came up while we were explaining. We don't end the visit by standing up; we end it by checking *"is there anything else?"* and waiting through the silence.

Why all this saves money downstream

A patient who leaves with a clear written plan is less likely to:

• Self-prescribe at a pharmacy because they forgot what we said.
• Come back for a re-explanation visit.
• Spiral into anxiety because they Googled their symptoms after.
• End up in an emergency room for a problem that was already being managed.

We see roughly 8–10 patients per consultation day instead of 60. The fee is correspondingly higher. The downstream cost — investigations, repeat visits, complications — is lower. Whether that arithmetic works for you depends on your case. For complex chronic-disease patients, second-opinion seekers, and "I've already been to three doctors and no one helped" cases, the math usually does work.

Book a first consultation if you'd like to try this kind of visit.