Persoonsgerichte continuïteit: Een verkennende studie

Patient-centered continuity involves the development and use of a patient image in the successive contacts of a general practitioner with a patient. In the patient image the common history of doctor and patient is condensed. In this study two questions were examined: • Which components can be recognized in the patient image? • How do general practitioners use these components in their patient management? In an exploring study seven general practitioners applicating Kolb's model of experimental learning passed six empirical cycles. In each cycle a hypothesis was developed and tested in practice: the participating doctors executed an instruction in five to ten contacts. Two major components could be recognized: the cognitive component, and the feeling component. Within the latter two categories appeared to be relevant: feelings about the relation with the patient and feelings about the patient as a person. We compared these feelings on four moments: immediately before a consultation, as soon as the patient had entered the consultation room, immediately after the consultation and one to two weeks after the consultation. We found that general practitioners reported more tension evoked by the patient if contact with the patient was near. If they reported such a feeling, they mentioned relatively few feelings about this patient as a person, at that moment. In tincognitive component a distinction could be made between the easily transferable knowledge of the patients disease or illness history, and knowledge about the patients way of coping with health problems which cannot easily be transferred to another doctor. The patient image almost always influenced patient management in general practice. A continuing relationship leads up to less action rather than more