Doctor-patient communication in general practice: an observational study in six European countries

Nowadays the importance of doctor-patient communication is undisputable. The objectives of this study were to describe the features of the communicative behaviour of general practitioners with special attention to doctor-patient communication in relation to the length of the consultation and the diagnosis. Method: 3674 videotaped consultations of 190 general practitioners in 6 European countries were analysed by means of the Roter Interaction Analysis System. Results: The communicative behaviour of the GP can be described as a ?standard operating procedure? consisting of 8 % social behaviour, 15 % agreement, 4 % rapport building, 10 % partnership building, 11% giving directions, 28 % giving information, 14 % asking questions and 7 % counselling. The consultation length (mean for all countries 10.7 minutes) was different in the 6 countries: Belgium and Switzerland had the longest consultations (about 15 minutes), Spain and Germany the shortest (about 7 minutes). The most important determinants of longer consultations were: female patients, psychosocial problems as reason for encounter, the number of problems and the location of the practice in a town. In a long consultation doctors took more time for social talk, they gave more attention to the relation or contact with the patient, they listened more extensively, especially to psychosocial problems and they gave more information as compared to short consultations. Concerning the relation between communication and diagnoses the most important differences were found for consultations about psychosocial problems as compared to all other diagnostic categories. In these consultations doctors showed more affective behaviour, were more concerned about having a good relationship with their patients, asked more questions and gave less information than in other consultations. The percentages of utterances in the other diagnostic categories were pretty similar. Conclusions: The GPs in this study adopt a patient-centred approach. Forty years of research and education seem to have influenced the behaviour of the doctors studied. The GPs make a distinction between bio-medical and psychosocial problems of the patient. They adapt their communicative approach accordingly. There is a remarkable inter-country difference in consultation length. Nevertheless this does not affect the conclusion that the consultation is a ?standard operating procedure?