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The informative process between patients and their doctors: do correlate doctors' and patients' opinions?
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Individual presentations / Patient Education and Counseling 34 (1998) S5 –S41
The level of knowledge was high: 71,1 % of respondents scored 4 or 5 items out of 5 correctly. The attitude towards the law turns out to be ambivalent. Respondents were positive about the law creating clarity in the rights of patients and the tasks of professionals. However, almost half of the respondents consider the law 1) to lead to defensive behaviour on the part of medical specialists and 2) too time consuming. Nurses tended to be more positive than medical specialists (p , .001). Respondents consider themselves efficacious in informing patients and letting them take decisions. However, they report difficulty in informing patients from ethnic minorities, in ascertaining that patients understand the information given and in knowing exactly what information has to be conveyed. Aids are used by 134 respondents. Most users consider aids to be feasible (70,2%) and helpful in clinical practice (64,8%). The appreciation of the aid used and the attitude towards the law are positively related (r 5 .30) Conclusion. To enhance performance of informed consent 1) the attitude towards the law might have to be ameliorated, 2) health care professionals may have to be trained in specific behaviours and 3) the use of aids may have to be stimulated. The informative process between patients and their doctors: do correlate doctors’ and patients’ opinions? Dr Felipe Aizpuru. Basque Health Service, Head of the ´ de health research unit– Araba health district, Fernandez Lezeta, 14 -INT-48, 01009 VITORIA, SPAIN. Introduction. Most patient and consumer surveys highlight doctor-patient communication as one of the weakest factors on the doctor-patient relationship. Patients are more or less dissatisfied with the amount of information given, with the lack of written information, and with other related aspects. This work tries to know the opinion of the doctors regarding the information given in general practice, and to compare it with that of their patients. Methods. In a first phase, a random sample of 1852 patients of 101 general practitioners throughout the Basque Country were interviewed after their consultations. One year later, the doctors were offered to answer another questionnaire. Both surveys were administered in the health centre by trained interviewers. Results. Response rates were 86 % and 81 %, respectively.More than a third of the doctors do not recognise the existence of any barriers to the communication with their patients. 25 % thinks that the barriers arise from some circumstances of the patient -in particular the cultural level- and of the system -in particular, the short time available per patient; 24 % blames only the health system and 10 % only the patient. Finally, a 6 % believes that some or all the responsibility for the barriers to communicate belongs to the doctor.
Comparing both sides’ opinions, three quarters of the sample of doctors consider that their patients are well informed, while 62 % of these declared they wanted more information on their problem after the consultation; 39 % of the doctors says they never use technical words, but 89 % of the patients considered that doctors use very often such technical words; 52 % of the doctors says they regularly give written information to the patients, whereas 77% of these claim they do not receive it. Conclusions. 1. Doctors deny any implication in the problem of the barriers to the communication. 2. Doctors and patients bear opposite views on important issues of the communication process. A review of comparative approaches to modelling the consultation in primary care Peter Bower, Linda Gask, Carl May (a), Nicola Mead. (a) Department of General Practice, University of Manchester, Rusholme Health Centre, Waimer Street, Rusholme, Manchester M14 5 NP, UK. Introduction. An extensive research literature on the doctor-patient consultation in primary care has emerged over the latter half of the 20th century. However, despite advances in theory and practice, no universally accepted theory of the consultation exists. Rather, researchers have adopted a number of alternative models of the consultation based on their disciplinary preoccupations and analytic tools. The existence of competing models can lead to fragmentation, confusion over terminology and ambiguity concerning the agenda for future research. This paper reviews the models currently used in studies of the consultation, assesses their comparative strengths and weaknesses and suggests possible directions for future work. Method. Key conceptual and empirical literature on the doctor-patient consultation in primary care was reviewed. A framework was adopted to describe and contrast models of the consultation in terms of: (1) the observations on which they are based, (2) key theoretical concepts, (3) research methods adopted, and (4) implications for training and research. Results and discussion. Four main approaches to modelling the consultation were identified from the literature: psychodynamic, clinical-observational, social-psychological and sociological. A description and critique of each model is presented. The models differ along the following dimensions: objective vs. subjective focus; quantitative vs. qualitative research methods; focus on doctor vs. patient; focus on individuals vs. relationships; medical vs. general context; descriptive vs. prescriptive concerns. While overall integration of the models to form an empirically testable theory of the consultation may not be a feasible option, there is value in encouraging research which is not constrained entirely within a single model. A number of methods for achieving this are discussed.
Individual presentations / Patient Education and Counseling 34 (1998) S5 –S41
The level of knowledge was high: 71,1 % of respondents scored 4 or 5 items out of 5 correctly. The attitude towards the law turns out to be ambivalent. Respondents were positive about the law creating clarity in the rights of patients and the tasks of professionals. However, almost half of the respondents consider the law 1) to lead to defensive behaviour on the part of medical specialists and 2) too time consuming. Nurses tended to be more positive than medical specialists (p , .001). Respondents consider themselves efficacious in informing patients and letting them take decisions. However, they report difficulty in informing patients from ethnic minorities, in ascertaining that patients understand the information given and in knowing exactly what information has to be conveyed. Aids are used by 134 respondents. Most users consider aids to be feasible (70,2%) and helpful in clinical practice (64,8%). The appreciation of the aid used and the attitude towards the law are positively related (r 5 .30) Conclusion. To enhance performance of informed consent 1) the attitude towards the law might have to be ameliorated, 2) health care professionals may have to be trained in specific behaviours and 3) the use of aids may have to be stimulated. The informative process between patients and their doctors: do correlate doctors’ and patients’ opinions? Dr Felipe Aizpuru. Basque Health Service, Head of the ´ de health research unit– Araba health district, Fernandez Lezeta, 14 -INT-48, 01009 VITORIA, SPAIN. Introduction. Most patient and consumer surveys highlight doctor-patient communication as one of the weakest factors on the doctor-patient relationship. Patients are more or less dissatisfied with the amount of information given, with the lack of written information, and with other related aspects. This work tries to know the opinion of the doctors regarding the information given in general practice, and to compare it with that of their patients. Methods. In a first phase, a random sample of 1852 patients of 101 general practitioners throughout the Basque Country were interviewed after their consultations. One year later, the doctors were offered to answer another questionnaire. Both surveys were administered in the health centre by trained interviewers. Results. Response rates were 86 % and 81 %, respectively.More than a third of the doctors do not recognise the existence of any barriers to the communication with their patients. 25 % thinks that the barriers arise from some circumstances of the patient -in particular the cultural level- and of the system -in particular, the short time available per patient; 24 % blames only the health system and 10 % only the patient. Finally, a 6 % believes that some or all the responsibility for the barriers to communicate belongs to the doctor.
Comparing both sides’ opinions, three quarters of the sample of doctors consider that their patients are well informed, while 62 % of these declared they wanted more information on their problem after the consultation; 39 % of the doctors says they never use technical words, but 89 % of the patients considered that doctors use very often such technical words; 52 % of the doctors says they regularly give written information to the patients, whereas 77% of these claim they do not receive it. Conclusions. 1. Doctors deny any implication in the problem of the barriers to the communication. 2. Doctors and patients bear opposite views on important issues of the communication process. A review of comparative approaches to modelling the consultation in primary care Peter Bower, Linda Gask, Carl May (a), Nicola Mead. (a) Department of General Practice, University of Manchester, Rusholme Health Centre, Waimer Street, Rusholme, Manchester M14 5 NP, UK. Introduction. An extensive research literature on the doctor-patient consultation in primary care has emerged over the latter half of the 20th century. However, despite advances in theory and practice, no universally accepted theory of the consultation exists. Rather, researchers have adopted a number of alternative models of the consultation based on their disciplinary preoccupations and analytic tools. The existence of competing models can lead to fragmentation, confusion over terminology and ambiguity concerning the agenda for future research. This paper reviews the models currently used in studies of the consultation, assesses their comparative strengths and weaknesses and suggests possible directions for future work. Method. Key conceptual and empirical literature on the doctor-patient consultation in primary care was reviewed. A framework was adopted to describe and contrast models of the consultation in terms of: (1) the observations on which they are based, (2) key theoretical concepts, (3) research methods adopted, and (4) implications for training and research. Results and discussion. Four main approaches to modelling the consultation were identified from the literature: psychodynamic, clinical-observational, social-psychological and sociological. A description and critique of each model is presented. The models differ along the following dimensions: objective vs. subjective focus; quantitative vs. qualitative research methods; focus on doctor vs. patient; focus on individuals vs. relationships; medical vs. general context; descriptive vs. prescriptive concerns. While overall integration of the models to form an empirically testable theory of the consultation may not be a feasible option, there is value in encouraging research which is not constrained entirely within a single model. A number of methods for achieving this are discussed.