Concerns voiced by patients and GPs’ responses during psychosocial visits in primary care: a historical cross-sectional studyReportar como inadecuado

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BMC Family Practice

, 15:188

Knowledge, attitudes, behaviors, education, and communication


BackgroundIn a recent study comparing psychosocial consultations prior to and after the implementation of national clinical guidelines in the Netherlands, we found that general practitioners GPs showed less empathy in the more recent consultations. As a consequence, patients possibly have less scope to express their worries. The objective is to investigate whether patients have become more reluctant to open up about their concerns during psychosocial consultations and how GPs respond.

MethodsConsultations from previous study samples videotaped between 1977 and 2008 and categorized by GPs as `completely psychosocial’ were selected for the present study. These consultations were observed using the Verona Coding Definitions of Emotional Sequences VR-CoDES to capture cues and concerns expressed by patients and GPs’ immediate responses. We compared consultations prior to N = 121 and after N = 391 introduction of national clinical guidelines in the 1990s.

ResultsIn 92% of the consultations, patients presented at least one worry. These were most often expressed implicitly. However, the proportion of consultations containing at least one explicit concern changed from 24% to 37% over time. The increased number of expressed cues and concerns was partly explained by a change in GP characteristics; the latter sample contained more female and more experienced GPs. Furthermore, cues and concerns were more often expressed during later phases of consultations in recent years.

ConclusionsOur study shows that patients have become somewhat more explicit in expressing their worries. However, GPs need to be aware that, still, most worries are expressed implicitly and that new concerns may appear towards the end of consultations.

KeywordsDoctor-patient relations General practice Cues Empathy Psychosocial factors AbbreviationsGPGeneral practitioner

GPsGeneral practitioners

VR-CoDES-CCVerona coding definitions of emotional sequences - cues and concerns

VR-CoDES-PVerona coding definitions of emotional sequences - provider’s responses

ICPCInternational Classification for Primary Care

ICCIntraclass correlation

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Autor: Ligaya Butalid - Peter FM Verhaak - Sandra van Dulmen - Jozien M Bensing


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