Open Access Highly Accessed Research article

Shifts in doctor-patient communication between 1986 and 2002: a study of videotaped General Practice consultations with hypertension patients

Jozien M Bensing12*, Fred Tromp3, Sandra van Dulmen1, Atie van den Brink-Muinen1, William Verheul1 and François G Schellevis14

Author Affiliations

1 NIVEL, Netherlands Institute for Health Services Research, PO Box 1568, 3500 BN, Utrecht, The Netherlands

2 Utrecht University, Department of Health Psychology, Heidelberglaan 1, 3584 CS, Utrecht, The Netherlands

3 Utrecht Medical Center St. Radboud, Department of Postgraduate Training for General Practice, PO Box 9120, 6500 HB Nijmegen, The Netherlands

4 VU, University Medical Centre, Department of General Practice, Van der Boechorststraat 7 1081 BT Amsterdam, The Netherlands

For all author emails, please log on.

BMC Family Practice 2006, 7:62  doi:10.1186/1471-2296-7-62

Published: 25 October 2006

Abstract

Background

Departing from the hypotheses that over the past decades patients have become more active participants and physicians have become more task-oriented, this study tries to identify shifts in GP and patient communication patterns between 1986 and 2002.

Methods

A repeated cross-sectional observation study was carried out in 1986 and 2002, using the same methodology. From two existing datasets of videotaped routine General Practice consultations, a selection was made of consultations with hypertension patients (102 in 1986; 108 in 2002). GP and patient communication was coded with RIAS (Roter Interaction Analysis System). The data were analysed, using multilevel techniques.

Results

No gender or age differences were found between the patient groups in either study period. Contrary to expectations, patients were less active in recent consultations, talking less, asking fewer questions and showing less concerns or worries. GPs provided more medical information, but expressed also less often their concern about the patients' medical conditions. In addition, they were less involved in process-oriented behaviour and partnership building. Overall, these results suggest that consultations in 2002 were more task-oriented and businesslike than sixteen years earlier.

Conclusion

The existence of a more equal relationship in General Practice, with patients as active and critical consumers, is not reflected in this sample of hypertension patients. The most important shift that could be observed over the years was a shift towards a more businesslike, task-oriented GP communication pattern, reflecting the recent emphasis on evidence-based medicine and protocolized care. The entrance of the computer in the consultation room could play a role. Some concerns may be raised about the effectiveness of modern medicine in helping patients to voice their worries.