Changes in doctor-patient communication in general practice

Abstract

Aim of the study The aim of this thesis was to investigate changes in doctor-patient communication, within the context of changes over the course of time in general practice care in the Netherlands. We focused on the question: How are changes in general practice (shifts in approaches) reflected in doctor-patient communication (shift in behavior)? We studied a shift from an approach that emphasized comprehensive, personal care toward an approach with a greater focus on evidence-based medicine. Methods To investigate this shift, we observed and compared general practice consultations prior to and after the implementation of various guidelines to study whether GP communication styles display elements of reconciliation between the use of clinical guidelines and the core value of comprehensive and personal care in daily practice. Main findings The findings show that consultations after the implementation of guidelines received higher quality ratings on doctor-patient communication, in particular regarding the quality of biomedical communication. Furthermore, our observational studies indicate that GPs have become more aware of psychosocial aspects that may contribute to physical complaints presented by patients. However, we also found that GPs placed more emphasis on providing biomedical information and advice, rather than on showing compassion during consultations. We also focused on the role of patients and found that patients were not likely to voice their worries openly. Conclusions It is challenging for GPs to find an appropriate balance between providing care in accordance with evidence-based knowledge and guidelines without losing sight of the 'patient-as-person'. In addition, the role of the patient is changing: they are expected to take responsibility for own health. However, patients also experience challenges in finding a balance between taking responsibility and sharing their vulnerability with their GP.