Primary care consultation predictors in men and women: a cohort study

BACKGROUND: Women visit their doctors more than men, but comparatively few studies have explored gender differences in consultation in detail. AIMS: To identify the factors that predicted the number of primary care consultations in men and women over a 5-year period. DESIGN OF STUDY: Prospective cohort study with three waves of data collection by postal questionnaire. SETTING: A single suburban general practice in Greater Manchester, UK. METHOD: Consultation data were sought from primary care records on a random sample of 800 adults. The main outcome measure was the number of consultations over the 5 years of the study. Questionnaire measures included the 12-item version of the General Health Questionnaire, the Illness Attitude Scales, a somatic symptom scale, a fatigue scale, and a functional assessment of disability. RESULTS: Consultation data were obtained on 738 patients (445 women, 293 men, 92% of selected subjects). Longitudinal models of consultation over 5 years showed that changes in psychological distress were more strongly associated with consultation in women than in men, whereas cognitive factors (negative illness attitudes) were more strongly associated with the consultation rate in men than women. CONCLUSION: The predictors of consultation in primary care may be different for men and women. A fuller understanding of the reasons for consultation may enable primary care doctors to better help individual patients, as well as perhaps contributing more generally to the development of gender specific interventions for those who consult unusually frequently.     

Comparison of consultation rates in primary care attenders with and without seasonal affective disorder

BACKGROUND: There is a lack of published information about the consultation patterns of patients with seasonal affective disorder (SAD) in primary care, when compared with non-seasonal controls (NSCs). METHODS: Interview-confirmed SAD cases (n=90) were age- and sex-matched to two controls without significant seasonal morbidity on the Seasonal Pattern Assessment Questionnaire (SPAQ) (non-seasonal controls, NSCs). A comparison of their consultation rates was made using data abstracted from primary care records over 4 years. RESULTS: The monthly rate of general practice consultations for SAD cases was significantly higher than that for NSCs. There was a significant difference in the median number of consultations in winter and autumn between the two groups. The matched multivariate analysis revealed that February and April were the independent months in which cases of SAD had significantly more consultations than NSCs. LIMITATIONS: Optimal diagnostic criteria for SAD have not been determined and our criteria may have been over-inclusive. CONCLUSION: In addition to a marked difference in monthly consultation rates between SAD cases and NSCs, the data demonstrate a difference in the pattern of seasonality of these rates. It is possible that increased frequency of consultation, in particular during the winter months (in patients who score as a case SPAQ), could be used as an indication of SAD in primary care.     

Surgical pathology extradepartmental consultation practices

OBJECTIVES: To document the practice parameters and case characteristics associated with personal (expert) consultations. We also examine the value, level of participant (customer) satisfaction, turnaround time, and rate of personal consultations. DESIGN: We asked participants in the College of American Pathologists' Q-Probes program to document cases sent for consultation during 4 months or up to 20 cases. They documented patient and specimen characteristics, the turnaround times, and the participants' levels of satisfaction with the consultation experience. PARTICIPANTS: One hundred eighty laboratories/surgical pathology practices. One hundred seventy-two (95.6%) were from the United States; the remainder were located in Canada and Australia. MAIN OUTCOME MEASURES: Rate and turnaround time of consultations and participant level of satisfaction. RESULTS: A total of 2746 consultation cases were examined for an aggregate consultation rate of 0.5% (median, 0.7%). Institutions with a higher occupied bed size and a greater number of surgical pathology cases both had lower consultation rates (P < or =.05). The median turnaround time (defined as the interval from the date on which the case was sent to the date on which the diagnosis was received) was 6 days. Twenty-nine percent and 68% of cases had a turnaround time within 3 and 7 days, respectively. Fifty-two percent of cases were sent to nationally known experts, and 32% were sent to local experts. Skin (18.0%), hematolymphoid (11.6%), and breast (9.6%) specimens were most commonly sent for consultation. In 70.5% of cases, the consultant confirmed the referring pathologist's original diagnosis, but in 15.9% of cases, the consultant also added significant information. Satisfaction rates were higher with faster turnaround times and verbal reporting. Satisfaction rates were lower for cases in which the patient or the clinician requested the consultation and in which the consultant's diagnosis was ambiguous. CONCLUSIONS: This study establishes a multi-institutional consultation rate of 0.5%, defines the nature of surgical pathology consultations, and demonstrates that satisfaction with consultations is associated with a faster turnaround time and receipt of additional, clinically meaningful information.     

Cost analysis of store-and-forward telepsychiatry as a consultation model for primary care

Store-and-forward telepsychiatry, or asynchronous telepsychiatry (ATP), which allows clinical data, including video to be collected to be reviewed at a later time by a specialist, has been described as a feasible alternative to real-time telepsychiatry, or synchronous telepsychiatry (STP), as a consultation model for primary care. In theory, ATP should be economically more cost-effective than STP due to the increased flexibility of patient data collection and the substitution of the time of specialists with that of lower-cost providers. The aim of this study was to conduct a retrospective cost-analysis comparing ATP with STP and traditional in-person psychiatric consultations in the primary care setting. One hundred and twenty five ATP consultations were performed and fixed and marginal costs were calculated for each model using inputs such as equipment costs, time spent by providers and support staff, and hourly salaries. The fixed costs were $7,000 and $20,000 for ATP and STP and marginal costs were $68.18, $107.50, and $96.36, respectively, for the three groups. STP was the most expensive of the three types of consultations. ATP became the most cost-effective of the three models beyond 249 consultations. The marginal cost savings of ATP were due to substitution of low-cost providers for specialists. ATP represents a potential disruptive healthcare process that could allow more affordable care to be delivered to a larger population of patients. A full accounting of ATP's efficiency will require further studies, including prospective cost-benefit analyses from the perspectives of the patient, provider, and society.     

Deprivation, psychological distress, and consultation length in general practice.

BACKGROUND: Recent research has shown the benefits of longer consultations in general practice. Approximately 40% of patients presenting to general practitioners (GPs) are psychologically distressed. Studies have shown that psychological morbidity increases with increasing socioeconomic deprivation. The combined effects of psychological morbidity and socioeconomic deprivation on consultation length are unknown. In addition, though it is known that doctors correctly identify half their distressed patients as such, the effect of consultation length on identification is unknown. AIM: To examine factors associated with presentation and recognition of psychological distress in GPs' surgeries and the interaction of these factors with consultation length. DESIGN OF STUDY: A cross-sectional study. SETTING: Nine general practices in the West of Scotland, involving 1075 consultations of 21 full-time GPs. METHOD: The main outcome measures were patient psychological distress (measured by General Health Questionnaire-12), doctors' identification of psychological distress, consultation length, and Carstairs deprivation category scores. RESULTS: The mean consultation length was 8.71 minutes (SD = 4.40) and the prevalence of positive GHQ scores was 44.7%. Increasing GHQ (greater psychological distress) and lower deprivation category scores (greater affluence) were associated with longer consultations. Positive GHQ scoring increased with greater socioeconomic deprivation and also peaked in the 30 to 39 years age group. Recognition of psychological distress was greater in longer consultations (50% increase in consultation length associated with 32% increase in recognition). CONCLUSION: Increasing socioeconomic deprivation is associated with higher prevalence of psychological distress and shorter consultations. This provides further evidence to support Tudor Hart's 'inverse care law' and has implications for the resourcing of primary care in deprived areas.     

Rectal and postmenopausal bleeding: consultation and referral of patients with and without severe mental health problems

BACKGROUND: People with severe mental health problems receive less effective care for some physical conditions. There is concern that this could apply to rectal bleeding or postmenopausal bleeding. Published estimates of consultation rates and outcomes for these symptoms vary widely. AIM: To estimate rates of first-ever consultation for rectal bleeding and postmenopausal bleeding in general practice, together with subsequent referrals and outcomes. To identify inequalities for patients with severe mental health problems. DESIGN OF STUDY: Cohort study. SETTING: Primary care. METHOD: Patients with first-ever consultations for rectal or postmenopausal bleeding were identified among more than 3 million patients from 328 practices contributing routine data to the QRESEARCH database. Their records were followed for 2 years. RESULTS: There were 30 175 first consultations for rectal bleeding (2.6 per thousand patients per year at age 25-29 years, rising to 4.8 over age 85 years) and 10 142 for postmenopausal bleeding (highest at 7.4 per thousand per year aged 55-59 years). Overall, 2.2% of those with rectal bleeding and 1.7% of those with postmenopausal bleeding went on to have a relevant cancer diagnosis within 2 years. Cancer risk was strongly related to age, and was higher for males with rectal bleeding than females with rectal bleeding. Recorded referrals were at similar rates among patients with and without severe mental health problems. CONCLUSION: The rate of first consultations for rectal bleeding or postmenopausal bleeding is relatively low. Less than 2.5% overall have a relevant cancer diagnosis within 2 years. There is no evidence of inequality in referral for patients with severe mental health problems.     

Predictors of weight discussion in primary care consultations: A multilevel modeling approach

ObjectiveTo understand how primary care weight-related communication processes are influenced by individual differences in primary care practitioner (PCP) and patient characteristics and communication use.MethodsTwo multilevel logistic regression models were calculated to predict the occurrence of 1) weight-related discussion and 2) weight-related consultation outcomes. Coded communication data (Roter Interaction Analysis System) from 218 video-recorded consultations between PCPs and patients with overweight and obesity in Scottish primary care practices were combined with their demographic data to develop the multilevel models.ResultsWeight-related discussions were more likely to occur when a greater proportion of PCP’s total communication was partnership building and activating communication. More discrete weight discussions during a consultation predicted weight-related consultation outcomes. Patient BMI positively predicted both weight-related discussion and consultation outcomes.ConclusionThis work demonstrates that multilevel modeling is a viable approach to investigating coded primary care weight-related communication data and that it can provide insight into the impact that various patient and PCP factors have on these communication processes.Practice implicationsThrough the increased use of partnership building and activating communications, and by engaging in shorter, but more frequent, discussions about patient weight, PCPs may better facilitate weight-related discussion and weight-related consultation outcomes for their patients.     

Triadic communication in the primary care paediatric consultation: a review of the literature.

BACKGROUND: Children aged 6-12 years are usually seen in primary care with an adult carer. It is a government and professional priority for doctors to try and involve these children in their medical consultations. AIM: To ascertain the evidence available on the amount and type of involvement that children in the 6-12 year age group have in their primary care consultations when the consultation was held with a child, a GP, and an adult. DESIGN OF THE STUDY: Literature review. METHOD: Data sources included MEDLINE, CINAHL, EMBASE, and ERIC, The Cochrane library, PsychINFO, Web of Science and Wilson's Social Science abstracts, hand searching for references, and contact with authors. RESULTS: Twenty-one studies were selected for inclusion in the study. Children were found to have little quantitative involvement in their own consultations. They may take part during information gathering but are unlikely to participate in the treatment planning and discussion parts of the consultation. CONCLUSION: Children in the 6-12 year age group have little meaningful involvement in their consultations.     

The exceptional potential of the consultation revisited.

A new framework is proposed for analysing the consultation in primary care, and for integrating other models relevant to the consultation. Use of communication skills helps to reconcile the respective agendas of doctor and patient into a negotiated plan, which includes both management of problems and health promotion. Achieving the potential of consultations depends on cooperation between patient and doctor, and on sufficient time for appointments.     

Long to short consultation ratio: a proxy measure of quality of care for general practice.

Eighty five general practitioners in the Lothian region recorded information on all surgery consultations on one day in every 15 for a year. On the basis of their mean consultation times with patients the working styles of the general practitioners were described as 'faster' (n = 24), 'intermediate' (n = 40) or 'slower' (n = 21). The 21,707 consultations which they carried out over this period were defined as 'short' (five minutes or less), 'medium' (six to nine minutes) or 'long' (10 minutes or more). Independent of doctor style, 'long' consultations as against 'short' consultations were associated with the doctor: (1) dealing with more of the psychosocial problems which had been recognized and were relevant to the patient's care; (2) dealing with more of the long term health problems which had been recognized as relevant; and (3) carrying out more health promotion in the consultation. Patients also reported greater satisfaction with longer consultations. The ratio of long:short consultations was found to be 0.28:1 for 'faster' doctors as against 2.3:1 for 'slower' doctors. When doctors in either group had more heavily booked surgeries or were running late, the long:short consultation ratio fell, in some cases by over 50%. This paper suggests that the ratio of long to short consultation length for a general practitioner might become the basis of a simply proxy measure of quality of care; and that its use might help monitor the effect of recent and proposed changes in the way in which general practice care is delivered.     

The relationship between census-derived socio-economic variables and general practice consultation rates in three town centre practices.

BACKGROUND: The relationship between socio-economic factors and consultation rates is important in determining resource allocation to general practices. AIM: To determine the relationship between general practice surgery consultation rates and census-derived socio-economic variables for patients receiving the same primary and secondary care. METHOD: A retrospective analysis was taken of computerized records in three general practices in Mansfield, North Nottinghamshire, with 29,142 patients spread over 15 electoral wards (Jarman score range from -23 to +25.5). Linear regression analysis of surgery consultation rates at ward and enumeration district levels was performed against Jarman and Townsend deprivation scores and census socio-economic variables. RESULTS: Both the Townsend score (r2 = 59%) and the Jarman score (r2 = 39%) were associated with surgery consultation rates at ward level. The Townsend score had a stronger association than the Jarman score because all four of its component variables were individually associated with increased consultations compared with four out of eight Jarman components. CONCLUSIONS: Even in practices not eligible for deprivation payments there were appreciable differences in consultation rates between areas with different socio-economic characteristics. The results suggest that the variables used to determine deprivation payments should be reconsidered, and they support suggestions that payments should be introduced at a lower level of deprivation and administered on an enumeration district basis.     

Psychosocial and illness related predictors of consultation rates in primary care--a cohort study

BACKGROUND: Despite extensive research, the reasons why patients consult their doctors are unclear. The aim of the current study was to identify the psychosocial and illness related factors that independently predicted primary care consultation over a 5-year period. METHOD: We carried out a prospective, population-based cohort study with three waves of data collection by postal questionnaire in one general practice in Greater Manchester (UK). Consultation data were sought from primary care records on a random subsample of 800 adult patients. The main outcome measure was the number of consultations (including surgery and home visits) over the 5 years of the study as determined by raters blind to questionnaire responses. Questionnaire measures included the 12-item version of the General Health Questionnaire, the Illness Attitude Scales, a somatic symptom scale, a fatigue scale, a functional assessment of disability. RESULTS: Consultation data were obtained on 738 patients (92% of selected subjects), who accounted for 12182 consultations. Negative illness attitudes, the presence of physical and psychiatric disorder, health anxiety, changes in psychological distress, reported physical symptoms and demographic factors such as age and sex were independently associated with consultation over a 5-year period. These variables together accounted for a difference of ten consultations per year between groups. CONCLUSION: Consultation in primary care is a complex behaviour with a complex aetiology. Terms such as 'frequent attenders' may be less helpful than recognizing a number of dimensions that operate across the whole spectrum of consultation frequency. Future research should consider the wider context of consultation.     

The effects of telephone consultation and triage on healthcare use and patient satisfaction: a systematic review

BACKGROUND: In recent years there has been a growth in the use of the telephone consultation for healthcare problems. This has developed, in part, as a response to increased demand for GP and accident and emergency department care. AIM: To assess the effects of telephone consultation and triage on safety, service use, and patient satisfaction. DESIGN OF STUDY: We looked at randomised controlled trials, controlled studies, controlled before/after studies, and interrupted time series of telephone consultation or triage in a general healthcare setting. SETTING: All healthcare settings were included but the majority of studies were in primary care. METHOD: We searched the Cochrane Central Register of Controlled Trials, EPOC specialised register, PubMed, EMBASE, CINAHL, SIGLE, and the National Research Register and checked reference lists of identified studies and review articles. Two reviewers independently screened studies for inclusion, extracted data, and assessed study quality. RESULTS: Nine studies met our inclusion criteria: five randomised controlled trials; one controlled trial; and three interrupted time series. Six studies compared telephone consultation with normal care; four by a doctor, one by a nurse, and one by a clinic clerk. Three of five studies found a significant decrease in visits to GPs but two found an increase in return consultations. In general at least 50% (range = 25.5-72.2%) of calls were handled by telephone consultation alone. Of seven studies reporting accident and emergency department visits, six showed no difference between the groups and one--of nurse telephone consultation--found an increase. Two studies reported deaths and found no difference between nurse telephone consultation and normal care. CONCLUSIONS: Although telephone consultation appears to have the potential to reduce GP workload, questions remain about its effect on service use. Further rigorous evaluation is needed with emphasis on service use, safety, cost, and patient satisfaction.     

Employing an extended Theory of Planned Behaviour to predict breastfeeding intention, initiation, and maintenance in White British and South-Asian mothers living in Bradford

Background.?Despite reported differences in breastfeeding rates amongst women of different ethnic groups, little research has investigated whether the thoughts and feelings (social cognitions) of women from these different groups during pregnancy influence their later breastfeeding behaviour. Objective.?This study investigates the extent to which social cognitions (based on the Theory of Planned Behaviour; TPB) predict differences in breastfeeding intentions, initiation, and maintenance between White British (WB) and South Asian (SA) women. Design and methods.?Two hundred and fifty women (predominantly WB or SA) in the last trimester of pregnancy completed a questionnaire based on the TPB. The women were followed up 6 months later and their breastfeeding during the previous 6 months was recorded. Results.?The TPB predicted significant variance in breastfeeding across the sample and was able to account for differences between SA and WB women. Affective attitudes (emotional reactions to breastfeeding) and moral norms (reactions about whether breastfeeding is right or wrong) were the strongest predictors of intentions. Intentions and affective attitudes were predictive of breastfeeding initiation, whilst only affective attitudes were predictive of breastfeeding maintenance. Conclusion.?Stronger intentions to breastfeed led to higher rates of breastfeeding amongst SA women. In turn, intentions were predicted by emotional and moral beliefs about breastfeeding, beliefs that were less positive amongst a WB sample. This suggests that those tasked with encouraging breastfeeding may need to have a different conversation with women about breastfeeding that goes beyond a focus on costs and benefits. STATEMENT OF CONTRIBUTION: WHAT IS ALREADY KNOWN ON THIS SUBJECT: South Asian women living in Britain are more likely to breastfeed their infants than White British women. The constructs of the Theory of Planned Behaviour have been shown to predict breastfeeding initiation and maintenance. However, few studies measure longer term breastfeeding or test whether TPB constructs from the extended TPB measured before the delivery of the baby predict breastfeeding initiation or maintenance. No studies have explored this amongst a British South Asian population. WHAT THIS STUDY ADDS: This study demonstrates that intentions and affective attitudes are strong predictors of initiation of breastfeeding, but that only affective attitude predicted maintenance of breastfeeding for 6 months. Moreover, we demonstrated that stronger intentions were able to explain the higher breastfeeding initiation rates and affective attitudes were able to explain the greater likelihood of maintenance of breastfeeding amongst South Asian women.     

Increasing patient participation using an extended consultation: an inner city study

An inner city practice in Birmingham has developed a new style of extended consultation to increase patient participation in primary care, based on previous initiatives in the practice, in particular allowing patients access to medical records, adopting an open reception style, and including consultations with a nurse practitioner. In a three stage consultation lasting approximately 30 minutes patients were offered a session with a receptionist for assisted access to medical records, a session of 15-20 minutes with a doctor or nurse and a self help session with a receptionist. This extended consultation was welcomed by patients, who showed a marked degree of participation, and it also increased the satisfaction and cooperation of project staff. This type of consultation provides a model for increasing patient participation in general practice.     

A prospective study of the consulting behaviour of older people with knee pain

BACKGROUND: Knee pain is common among older adults but only a minority consult their doctor about it. AIM: To determine predictors of new episodes of consultation in primary care among older people with knee pain. DESIGN OF STUDY: Population-based prospective cohort study linking baseline survey to primary care medical records. SETTING: Three general practices in North Staffordshire, UK. METHOD: Subjects were 1797 people aged > or =50 years who responded to a general population survey, reported knee pain in the previous 12 months and had no record of a knee disorder consultation in the 18 months prior to the survey. The main outcome measure was a record of a knee disorder consultation in the 18 months following the survey. RESULTS: The incidence of a new episode of general practice care was approximately 10% per year. Apart from chronicity (odds ratio [OR] = 1.5; 95% confidence interval [CI] = 1.1 to 2.1), measures of pain severity were not strong influences on future consultation. No social support (measured by having no partner) increased likelihood of future consultation (OR = 1.3; 95% CI = 1.0 to 1.8). Among those with chronic and severe pain, main predictors were previous experiences of health care (use of non-GP services OR = 1.8; previous knee injury OR = 1.7). Current depression reduced likelihood of consulting about the knee problem (OR = 0.6; 95% CI = 0.3 to 0.9). CONCLUSIONS: Knee pain is common in the older population but a minority consult their doctor about it. Severity of pain and disability is not a strong influence on consultation. For those more severely affected, depression may act as a barrier to healthcare use.     

Factors affecting the relationship between the timing of psychiatric consultation and general hospital length of stay

The purpose of this study was to examine the factors affecting the timing of psychiatric consultations and length of stay in the current managed care era. It also assessed the relationships between the timing of consultations and demographic/clinical characteristics. Medical records of 541 consecutive psychiatric consultation patients at a university teaching hospital in 2001 were reviewed for demographic characteristics, lengths of stay, number of days from admission to consultation, specialty services requesting consultations, reasons for the referral given by the referring physicians, and all five axes of DSM-IV. Earlier consultations independently predicted shorter lengths of stay. Delayed consultations were seen more often in women; surgical patients; those seen with a request to assess depression; and those seen with a diagnosis of adjustment disorder, delirium, or no psychiatric disorder. Delay in psychiatric consultations continues to be associated with longer lengths of stay in the current managed care environment. It is now possible that early detection strategies for high-risk patients with behavioral health problems in the medical setting, such as use of the INTERMED, may lead to reduction in delayed psychiatric consultations and thus shorter lengths of stay.     

Mental health and medical consultation in primary care settings

This paper examines the effect of psychiatric morbidity, as measured by the GHQ-60, on the probability of being in contact with a primary care physician, and the socio-demographic factors which influenced this effect. We found that the presence of psychiatric morbidity emerged as a major determinant of primary care utilization in both sexes, and about one-sixth of consultations in men and one-fifth of consultations in women could be attributed to it. Logistic modelling was used to investigate the joint effect on general practitioner consultation of psychiatric morbidity and seven socio-demographic variables. Sex, age, and psychiatric morbidity exerted independent, but not interactive, effects on consultation.     

Patient expectations from consultation with family physician

Aim

To assess patient expectations from a consultation with a family physician and determine the level and area of patient involvement in the communication process.

Method

We videotaped 403 consecutive patient-physician consultations in the offices of 27 Estonian family physicians. All videotaped patients completed a questionnaire about their expectations before and after the consultation. Patient assessment of expected and obtained psychosocial support and biomedical information during the consultation with physician were compared. Two investigators independently assessed patient involvement in the consultation process on the basis of videotaped consultations, using a 5-point scale.

Results

Receiving an explanation of biomedical information and discussing psychosocial aspects was assessed as important by 57.4-66.8% and 17.8-36.1% patients, respectively. The physicians did not meet patient expectations in the case of three biomedical aspects of consultation: cause of symptoms, severity of symptoms, and test results. Younger patients evaluated the importance of discussing psychological problems higher than older patients. The involvement of the patients was high in the problem defining process, in the physicians'' overall responsiveness to the patients, and in their picking up of the patient''s cues. The patients were involved less in the decision making process.

Conclusion

Discussing biomedical issues was more important for the patients than discussing psychological issues. The patients wanted to hear more about the cause and seriousness of their symptoms and about test results. The family physicians provided more psychosocial care than the patients had expected. Considering high patient involvement in the consultation process and the overall responsiveness of the family physicians to the patients during the consultation, Estonian physicians provide patient-centered consultations.The quality of physician consultation depends on the relationship between the patient and the physician, on the ability of the physician to understand patient’s expectations, and on the agreement between the patient and the physician on the problem (1-3). Traditionally, physicians in family practice and their patients have always known each other well and have shared previous experience (4). However, reorganization of health care systems, development of medical and information technology, and other recent changes in society have influenced the patient-physician relationship and new consultation styles have emerged (5). The traditional physician-oriented approach in health care has shifted to a patient-oriented approach (1,6-8), which includes patient satisfaction and compliance in addition to the outcomes of medical treatment (9,10).The importance of different aspects of patient-physician consultation and its association with the physician’s performance have been studied mostly in countries with a long tradition of comprehensive primary health care (1,9). Estonia belongs to the countries where a traditional, centralized health care system was transformed into a new patient-oriented system only 15 years ago (11,12). The new system today requires professionally trained family physicians and fixed lists of patients, which ensure patient access to the primary health care physician (11,12). It also requires a new format of patient-physician relationship and consultations.The aim of our study was twofold. First, we aimed to determine if and to what level patient expectations from the consultation with a family physician were met with respect to various biomedical and psychosocial aspects of the visit. The second aim was to assess the degree of patients’ involvement in the consultation process with family physicians.     

Does awareness of being video recorded affect doctors' consultation behaviour?

Four general practitioners, two of whom had no previous experience of video recording in the consultation, took part in a study to assess the effect of awareness of video recording on their consultation behaviour. A video camera was sited unobtrusively in each consulting room for a month during which five randomly selected surgeries were recorded with the doctors being informed at the time, and five without their being informed. The video recorded consultations were analysed using TIMER, a tool designed to measure objectively behaviour in terms of physical, verbal and secondary activities in consultations. The proportions of time spent on the 27 consultation parameters were compared when doctors were aware and unaware of the recording, using analysis of variance. This demonstrated only one significant difference, in the low frequency parameter of the doctor's exploration of the patients' concepts (P less than 0.05). In a secondary analysis of the first four consultations in each surgery, where any effect of the presence of the video camera would be expected to be most marked, there was again only one significant difference in the 27 parameters (in patient preparation; P = 0.01). No significant difference owing to awareness of video recording was found in consultation length, the number of problems dealt with, or previous inexperience of video recording. When surgeries at the start of the month were compared with those at the end, four significant differences (P less than 0.05) out of 108 areas were demonstrated both when the doctor was aware and unaware of video recording, and there was no consistency in the direction of the differences.(ABSTRACT TRUNCATED AT 250 WORDS)