A cross-sectional survey of patients' beliefs about stress and their help-seeking behaviour

BACKGROUND: Stress has become an increasingly common presentation in general practice. This may relate to an increase in stress in people's lives or a change in the meaning of stress and its conceptualisation as a legitimate problem for the GP. AIM: To explore patients' beliefs about stress, their association with help-seeking behaviour, and to examine differences by ethnic group. DESIGN OF STUDY: Cross-sectional survey of general practice patients attending to see their GP. SETTING: An inner-city London practice. METHOD: Consecutive general practice patients completed a questionnaire, which involved rating a series of symptoms for the extent to which they were associated with stress and describing their help-seeking behaviour. In total, 548 patients completed the questionnaire. Most patients described themselves as black Caribbean (n = 163), black African (n = 48), or white British (n = 187). RESULTS: The symptoms most frequently associated with stress were sleeping problems, feeling depressed, feeling panicky, having high blood pressure and feeling anxious; feeling ashamed, experiencing indigestion, having diarrhoea, feeling hot or cold, and suffering from constipation were least commonly associated to stress. This model of stress did not vary by ethnic group. Ethnic group differences were found for the association between the model of stress and help-seeking behaviour. Although white British patients consistently reported that the more a symptom was seen as indicative of stress, the more likely they would be to visit the doctor for that symptom, this association was not found for either black Caribbean or black African patients. CONCLUSIONS: The belief that stress-related symptoms are a legitimate problem for the GP is not universal and varies according to ethnic group. Stress is used by different patients in different ways and offers a variable pathway to the doctor.     

Patients' experiences and expectations of general practice: a questionnaire study of differences by ethnic group

BACKGROUND: Research has highlighted variations in morbidity, mortality and health needs by ethnic group, and suggests that some ethnic groups may receive a poorer service. AIM: To explore the impact of ethnic group on patients' experiences and expectations of their general practice consultation. DESIGN OF STUDY: Cross-sectional survey. SETTING: One general practice in a multicultural area of London. METHOD: A total of 604 consecutive patients attending their general practice (response rate = 60.4%) who described their ethnic group as white British, black African, black African Caribbean or Vietnamese completed a measure relating to their experiences and their expectations of the general practice consultation in terms of treatment, communication, patients' agenda, patients' choice and doctor consistency. RESULTS: No differences were found for the black African or black African Caribbean patients. The Vietnamese patients reported better experiences of communication, more focus on their agenda and more attention to their choices than the white British patients. However, they also reported expecting lower levels of communication, less focus on their own agenda and reported wanting less GP consistency than the other ethnic groups. CONCLUSION: Vietnamese patients state that they are receiving better standards of care in general practice than other ethnic groups. However, they also state that they expect less. This may illustrate a problem with assessing experiences of primary care. Higher scores of experience may not illustrate better consultations as such, but only better when compared with a lower level of initial expectation. A lower expectation is easier to fulfil.     

Patients'' views of a pharmacist-run medication review clinic in general practice.

BACKGROUND: Reviewing elderly patients' medication is a requirement of the National Service Framework for Older People. Many general practitioners have insufficient time to review patients' medications in a consultation. Pharmacist review has been offered as an alternative and this will be a new experience for many patients. AIM: To ascertain patients' views of a pharmacist-conducted medication review clinic, run in their general practice surgery. DESIGN OF STUDY: Qualitative study using focus group interviews. SETTING: General practices in Leeds Health Authority area. METHOD: Patients aged 65 years and over, who had attended a medicine review clinic, took part in focus groups that were recorded and transcribed. Units of information representing an idea were identified and similar ideas were grouped together as themes. RESULTS: Patients had a number of prior beliefs about the clinic. Most patients knew that the clinic's purpose was to review repeat medication, to find out more about their medicines, and to ask questions about efficacy and side effects. Some patients were suspicious about the purpose of the clinic but others welcomed the opportunity to have an in-depth review and an explanation of their condition and its treatment; some patients did not accept advice or were disappointed that their expectations were not fulfilled. Most patients were happy to attend a yearly review but some expressed guilt about attending the surgery too frequently. CONCLUSION: Patients who attended the medication review clinics expressed a range of views about the service. Further research into patients' and carers' opinions about medicine review is needed to inform the development of these services.     

The strategies used by general practitioners when providing information about medicines

Changes both inside and outside the consultation increase the chances that patients may gain information from sources other than their general practitioner (GP). Data from nine interviews and one focus group with British GPs were used to explore GPs' rationale for the information they provide when prescribing oral steroids and their perceptions of patients' expectations. GPs' communication strategies were associated with the type of relationship they sought to perpetuate with patients. Some GPs reported that decisions about the provision of information were based on their own judgements of what patients needed to know (paternalistic approach), while others reported attempts to take account of patients' existing knowledge and beliefs (mutualistic approach). All the GPs were aware of the availability of information about medical matters, and most believed that patients' expectations had increased. The communication strategies of some GPs may not be appropriate given the availability of medical information outside the consultation.     

A qualitative study of delay among women reporting symptoms of breast cancer.

BACKGROUND: Delayed presentation of symptomatic breast cancer of three months or more is associated with lower survival rates from the disease, yet 20% to 30% of women wait at least three months before consulting their general practitioner (GP) with breast symptoms. AIM: To explore the factors that influence GP consultation by women with breast cancer symptoms. DESIGN OF STUDY: Qualitative analysis of semi-structured interviews. SETTING: Forty-six women with newly diagnosed breast cancer, selected from 185 women recruited to a larger study. METHOD: Interviews were conducted eight weeks after diagnosis of breast cancer, comparing two groups of women divided according to the extent of delay between onset of symptoms and seeking medical care. Fifteen women had sought advice from their GP within two weeks of symptom discovery ('non-delayers' and 31 had waited 12 weeks or more before seeing their doctor ('delayers'). RESULTS: Women with breast symptoms who presented promptly to GPs recognised the seriousness of the symptom they had discovered more quickly than delayers. Perception of seriousness was influenced by the nature of the initial symptom and how far it matched the individual's expectations of breast cancer as a painless breast lump. Other factors affecting help-seeking included attitudes to GP attendance, beliefs about the consequences of cancer treatment, and perceptions of other priorities taking precedence over personal health. CONCLUSIONS: This analysis suggests that women need further information about the different types of breast cancer symptoms to assist symptom recognition, as well as encouragement to seek medical advice if a symptom is ambiguous. In addition, women may benefit from greater awareness of the benefits of early detection and reassurance about the improvements in quality of breast cancer care.     

Patients' reasons for not presenting emotional problems in general practice consultations.

BACKGROUND: Patients commonly do not mention emotional problems in consultations, and this is a factor in general practitioners' (GPs') difficulty in identifying psychological morbidity. AIM: To investigate patients' self-reported reasons for not disclosing psychological problems in consultations with GPs. METHOD: From nine general practices, a sample of patients with high General Health Questionnaire scores, who planned to present only somatic symptoms to the GP, were interviewed after their consultation with the GP. The interview covered their reasons for not mentioning emotional problems. A patient satisfaction questionnaire was administered. RESULTS: A total of 83 patients were interviewed. Sixty-four patients confirmed that they had not mentioned emotional problems in the consultation; 23 (36%) of these gave primarily realistic reasons for not presenting emotional problems (e.g. able to cope with distress), 29 (45%) gave reasons related to psychological embarrassment or hesitation to trouble the GP, and 12 (19%) were mainly deterred by the doctors' interview behaviours. The latter group had significantly lower satisfaction scores than patients in the other two groups. In addition, patients in all groups commonly reported perceptions of lack of time (48%) and that there is nothing doctors can do to help (39%) as barriers to mentioning emotional problems. CONCLUSION: An understanding of patients' reasons for not disclosing emotional problems can assist in identifying subgroups of patients with different management needs.     

Patients'' experiences of GP consultations for psychological problems: a qualitative study

BACKGROUND: The vast majority of patients with psychological problems are seen solely by their GP, but little is known about patients' perspectives regarding the variety of consultation skills that may be used in routine GP consultations with these patients. AIM: To identify which aspects of GP consultations patients presenting with psychological problems experience as helpful or unhelpful. DESIGN: Qualitative study. SETTING: Nine general practices in north central London. METHOD: Twenty patients, who had discussed psychological problems as a significant part of their index GP consultation, were asked in detail using the tape-assisted recall (TAR) method, about aspects of the consultation they had experienced as helpful or unhelpful. RESULTS: All patients described how the relationship with the GP helped or hindered them in discussing their problems; this was central to their experience of the consultation. An underlying attitude of genuine interest and empathy, within a continuing relationship, was highly valued. Patients also described how the GP helped them make sense of, or resolve their problems, and supported their efforts to change. CONCLUSION: These patient accounts suggest that routine GP consultations for psychological problems can have a powerful impact, at least short-term. The GP role in providing a safe place where patients feel they are listened to and understood should not be underestimated, particularly in the mental health context. Further research is required to investigate the longer-term impact of different GP behaviours on patient health outcomes. The TAR method has potential applications in primary care research and in the training of GPs and other health professionals.     

Who should give lifestyle advice in general practice and what factors influence attendance at health promotion clinics? Survey of patients' views.

BACKGROUND: Health promotion activity in general practice has increased greatly since 1990. A large proportion of this work is undertaken by practice nurses. Little is known about patients' views about the providers of health promotion or their views about general practice health promotion clinics. AIM: A study was carried out in 1992 to determine patients' views about the provision of health promotion advice by general practitioners and practice nurses and their views about attending health promotion clinics. METHOD: A postal questionnaire was sent to a random sample of 1750 patients aged 16 years and over from five general practices in south Tyneside. The questionnaire explored patients' preferences regarding health promotion advice from the general practitioner or practice nurse in relation to four areas of lifestyle advice and factors that might encourage patients to attend a health promotion clinic. RESULTS: A response rate of 75% was obtained from 1639 eligible patients. Receiving health promotion advice from either the general practitioner or the practice nurse was the most commonly preferred option expressed by patients overall. The ability of health promotion clinic staff to deal with patients' concerns about their illness and short waiting times were more likely to influence patients' attendance at health promotion clinics than the presence of a general practitioner or practice nurse. CONCLUSION: In the present study, many patients found health advice received from practice nurses and general practitioners equally acceptable. However, it was the ability of health professionals to respond to patients' health concerns in the health promotion clinic rather than the type of health professional running the clinic that was important for patients.     

What do patients want from doctors? Content analysis of written patient agendas for the consultation.

BACKGROUND: Although much has been written about what patients want when they contact their general practitioner (GP), there are no published data from large cohort studies of what patients expect. AIM: To describe the expectations of a large group of patients who consulted with their GPs. METHOD: A GP and a social sciences graduate carried out a content analysis of written agenda forms completed by 819 patients who consulted 46 randomly selected GPs. Inter- and intra-rater reliabilities were confirmed. RESULTS: A total of 756 (92%) agenda forms were returned. Inter-rater reliability was satisfactory (kappa > 0.6 for all but two main themes). Almost all patients had requests they wished to make of their doctor, 60% had their own ideas about what was wrong, and 38% had considered explanations about why they were unwell. Forty-two per cent and 24% of patients had consulted because they had reached the limit of their anxiety or tolerance respectively. Seven per cent, 4%, and 2% had comments, which were usually negative, to make about previous management, communication with doctors, or time in the consultation. CONCLUSION: These data demonstrate that most patients come to the consultation with a particular agenda. Failure to address this agenda is likely to adversely affect the outcome of many consultations.     

Giving patients an audiotape of their GP consultation: a randomised controlled trial.

BACKGROUND: Providing patients with an audiotape of their medical consultation has been a relatively common practice in oncology clinics for some years. However, broader generalisability of the technique has yet to be examined. AIMS: To investigate the efficacy of providing patients with an audiotape of their consultation in a general practice setting. DESIGN OF STUDY: Randomised controlled trial: 95 experimental participants, 85 controls. SETTING: Routine surgeries run by two general practitioners (GPs) in two different health centres. METHOD: All patients attending GP appointments were eligible for inclusion. Patients were followed up by telephone 7-10 days later. RESULTS: More than half (61%) of the patients who received a tape listened to it. Among listeners, 64% rated the tape useful or very useful; 24% noticed information not heard in the consultation. Half of listeners (46%) said that their understanding of the consultation improved after listening to the tape. Half of the listeners (48%) shared the tape with others, of whom 71% found sharing helpful or very helpful. However, 21% of those who shared the information with others found this unhelpful or very unhelpful, suggesting that patients may need to be briefed on the potential risks of sharing. At follow-up a week later, it emerged that being given a tape had no effect on adherence with GPs' advice, nor on anxiety about conditions. CONCLUSION: Providing patients with an audiotape of their GP consultation was positively rated by many patients. Although there were no detectable clinical effects at follow-up, the technique merits further evaluation in general practice.     

General practitioners' and patients' models of obesity: whose problem is it?

Primary care literature emphasises the importance of agreement and shared models in the consultation. This study compared general practitioners' (GPs') and patients' models of obesity. Questionnaires concerning beliefs about the causes, consequences and solutions to obesity were completed by 89 general practitioners (GPs) and 599 patients from practices across UK. In terms of causes, the results showed that the patients were more likely to attribute obesity to a gland/hormone problem, slow metabolism and stress than the GPs, whereas the GPs were more likely to blame eating too much. In terms of consequences, the patients rated difficulty getting to work more highly whereas the GPs regarded diabetes as more important. For the solutions to obesity, the two groups reported similar beliefs for a range of methods, but whereas the patients rated the GP and a counsellor as more helpful, the GPs rated the obese person themselves more highly. It is argued that patients show a self serving model of obesity by blaming internal uncontrollable factors for causing obesity yet expecting external factors to solve it. In contrast, GPs show a victim blaming model by attributing both cause and the solution to internal controllable factors. Such differing models have implications regarding the form of intervention likely to be used in primary care and indicate that whereas patients would prefer a more professional based approach, GPs would prefer a more patient-led one. Further, the results suggest that even if an intervention could be negotiated, success rates would be low as either the patient or the GP would be acting in contradiction to their beliefs about the nature of obesity.     

Diabetes and clinical laboratory tests: team medicine

The presentation at this symposium is from the following two perspectives: 1. Indispensability of team medicine for diabetes treatment: Once diabetes has been diagnosed, long-term treatment is essential. Diabetes is often due to a combination of unhealthy lifestyle factors, and treatment therefore requires patients to improve their lifestyles, a certain amount of stoicism also being needed. Patients also have to overcome events in their lives while suffering from diabetes, at the same time as controlling the diabetes, and such events cause stress for the patients, affecting them both psychologically and in terms of lifestyle, so patients' blood sugar levels are disturbed by interactions between stress and lifestyle factors. Medical personnel monitor the progression of numerous diabetic patients, and take different approaches to treatment on the basis of their experience and specialist knowledge. From various perspectives, maintenance of patients' will to continue with treatment is an important aspect of "team medicine". Enabling patients to be treated while feeling themselves to be supported by the treatment team is important, and is linked to empowerment of patients, which is the ultimate objective of the treatment guidelines. 2. Importance of team medicine, illustrated by diabetic nephropathy: If diabetic nephropathy progresses to Stage II or further, deterioration of the patient's condition is unavoidable. Medical personnel often think that the patients also will be concerned about the nephropathy, and will therefore not forget about having been told they have nephropathy. However, it has been found that, when subjective symptoms are absent, patients often do not fully understand the explanation, and forget about the nephropathy. It is therefore essential for medical personnel to appreciate that the risk of nephropathic progression is increased if patients do not remember about having nephropathy.     

General practitioner contacts with patients before and after deliberate self harm.

BACKGROUND: Deliberate self harm (DSH) is an increasingly common problem. Although much attention is focused on suicide prevention by psychiatric services, the role of the general practitioner (GP) in the prevention of suicidal behaviour and in the aftercare of DSH patients is also important. AIM: To examine the nature and timing of GP contacts with DSH patients before and after an episode of DSH, and patients' satisfaction with these contacts. DESIGN OF STUDY: Structured interviews with patients shortly after an episode of DSH and again approximately one year later. SETTING: A representative sample of 139 DSH patients presenting to a district general hospital. METHOD: Patients were interviewed shortly after DSH and at follow-up about GP contacts, prescribed medication and psychiatric symptoms. RESULTS: At the time of DSH, 91.4% of patients were diagnosed with a psychiatric disorder (depression 69.8%), with 28% receiving treatment from psychiatric services. Two-thirds of patients had been in contact with their GP in the month before DSH, but only 13.3% reported expressing suicidal thoughts. Patients consulted their GP in the week following DSH in 40.6% of cases. Over half (57.9%) the patients discussed the reasons for their DSH at the first consultation and 69.5% reported that this was helpful. Overall, 64.3% of patients were satisfied with the follow-up consultations. CONCLUSIONS: The major role of the GP in the prevention of suicidal behaviour is in the detection and treatment of depression, and in the aftercare of DSH patients.     

An analysis of referral patterns for dizziness in the primary care setting.

BACKGROUND: The majority of balance disorders are non life-threatening and symptoms will resolve spontaneously. However, some patients require further investigation and many disorders may benefit from specialist treatment it is unclear whether appropriate identification and referral of this group of patients presently occurs. AIM: To review the management of patients with symptoms of dizziness within primary care. METHOD: A retrospective review of the management of 503 patients who visited their general practitioner (GP) complaining of dizziness between August 1993 and July 1995. Management was then compared with local criteria. RESULTS: On average, 2.2% of patients per year at the practices studied consulted their GP about dizziness, amounting to 0.7% of all consultations. The most common GP diagnosis was of an ear, nose, and throat (ENT) disorder (33.8%). Similarly, many of the 16% referred were directed to ENT (36%) specialists. The proportion of patients referred was significantly higher in those seeing their GP at least twice, those with symptoms lasting a year or more, or where there were additional symptoms associated with the dizziness, indicative of a cardiac, ENT, or neurological disorder. Compared with the local criteria, 17% of management decisions were deemed inappropriate. The major failing was not referring appropriate patients. This group comprised patients with chronic, non-urgent symptoms, and were significantly older than those appropriately referred. CONCLUSION: Patients with chronic symptoms of dizziness, particularly the elderly, are under-referred for specialist consultation and, therefore, do not have access to appropriate treatment regimes. This suggests a need for further training of GPs and evaluation of therapeutic needs of elderly dizzy patients.     

Symptom interpretation and quality of life in patients with irritable bowel syndrome

BACKGROUND: Patients with irritable bowel syndrome (IBS) are often believed to attribute unexplained symptoms to physical disorders. We tested this hypothesis by assessing symptom interpretation, symptom severity, and quality of life in patients attending hospital gastroenterology clinics. AIM: The main aims of this study were: to assess the symptom attributional styles of hospital gastroenterological outpatients with IBS and non-IBS disorders in comparison with unselected patients attending their GP; to establish the relationships between attributional style, quality of life, and IBS severity score in hospital gastroenterology outpatients; and to test the hypothesis that the IBS severity score correlates with a somatising style of symptom attribution. DESIGN OF STUDY: Systematic quantitative analysis. SETTING: General practice and gastroenterology outpatient clincs. METHOD: Patients attending hospital gastroenterology clinics were recruited prospectively and completed validated questionnaires. These were the Medical Outcome Survey (MOS SF-36), the IBS Severity Score, and the Symptom Interpretation Questionnaire (SIQ). The latter measures the tendency to interpret somatic symptoms in three ways: as a physical disorder (somatising attributional style), as an emotional response to stress (psychologising attributional style), or as a normal experience (normalising attributional style). The diagnosis of IBS was based on the Rome II criteria; the control groups comprised gastroenterology outpatients with non-IBS diagnoses and unselected patients attending general practice. RESULTS: Quality of life in IBS patients attending hospital outpatients (n = 32, male:female ratio 9:23) was not significantly different from that of non-IBS patients (n = 70, male:female ratio 32:38). In all patient groups, the normalising style of symptom interpretation predominated; psychologising styles correlated with impaired quality of life in the mental health domains. In IBS patients, the tendency to seek a psychological explanation for physical symptoms correlated significantly with the severity of the abdominal pain. CONCLUSIONS: Symptom interpretation does not differ between IBS and non-IBS patients referred to hospital gastroenterology clinics. The tendency to attribute somatic symptoms to a physical disorder does not explain why only a minority of IBS subjects seek medical attention. The idea that most IBS patients are committed to a somatic explanation of symptoms appears to be a myth.     

Factors affecting the decision to consult with dyspepsia: comparison of consulters and non-consulters.

To identify factors associated with the decision to consult with dyspepsia, patients with dyspepsia were identified from a postal survey in the community. A random sample of 69 patients who had consulted their general practitioner and 66 patients with dyspepsia who had not consulted were interviewed in their homes. Differences in consultation behaviour were not explained by differences in self-reported severity or frequency of symptoms or by the presence of associated symptoms. The most striking difference between the two groups was concern among the consulters about the possible seriousness of symptoms. Consulters were also more likely to be worried about cancer and heart disease and to have experienced more disruptive or threatening life events than the non-consulters. These results emphasize the importance of looking beyond the presentation of common symptoms in general practice to patients' fears about the significance of the symptoms and to non-physical determinants of consultation behaviour.     

Characteristics of children consulting for cough, sore throat, or earache.

BACKGROUND: GPs are often consulted for respiratory tract symptoms in children. AIM: To explore characteristics of children, their parents, and their GPs that are correlated with consulting a GP for cough, sore throat, or earache. DESIGN OF STUDY: Second Dutch National Survey of General Practice (DNSGP-2) with a health interview and an additional questionnaire. SETTING: Children aged 0-17 years registered with 122 GPs in Dutch general practice. METHOD: Characteristics of patients and their GPs were derived from the DNSGP-2 health interview and a questionnaire, respectively. Characteristics of the illness symptoms and GP consultation were acquired by means of an additional questionnaire. Data were analysed using multivariate logistic regression. RESULTS: Of all children who completed the questionnaire, 550 reported cough, sore throat, or earache in the 2 weeks preceding the interview with 147 of them consulting their GP. Young children more frequently consulted the GP for respiratory symptoms, as did children with fever, longer duration of symptoms, those reporting their health to be 'poor to good', and living in an urban area. When parents were worried, and when a child or their parents were cued by someone else, the GP was also consulted more often. GP-related determinants were not associated with GP consultation by children. CONCLUSION: This study emphasises the importance of establishing the reasons behind children with respiratory tract symptoms consulting their GP. When GPs are aware of possible determinants of the decision to consult a GP, more appropriate advice and reassurance can be given regarding these respiratory symptoms, which are generally self-limiting.     

Prevalence of lower gastrointestinal symptoms and associated consultation behaviour in a British elderly population determined by face-to-face interview.

BACKGROUND: The incidence of organic lower gastrointestinal disease increases with age. However, the prevalence of lower gastrointestinal symptoms in a British elderly population is unclear, with previous epidemiological studies focusing on younger populations. Furthermore, there is little information about consultation behaviour associated with lower gastrointestinal symptoms. AIM: To determine the prevalence of lower gastrointestinal symptoms reported by randomly selected, elderly community subjects. METHODS: An age- and sex-stratified random sample of patients aged 65 years and over was drawn from a general practice register (n = 842). Those who had not refused to participate in an initial postal survey were invited to participate in a semi-structured physician interview at their own home to assess lower gastrointestinal symptomatology (n = 745). Non-participation bias and service use of all subjects were assessed from practice records. RESULTS: Five hundred and ninety-six (71%) patients were interviewed. Fifty-seven per cent of all participants had at least one lower gastrointestinal symptom. Individual symptoms and symptom complexes were common, affecting up to 32% of subjects. Only 24% of subjects with lower gastrointestinal symptoms consulted their general practitioner (GP) with such symptoms in the previous year. As few as 31% of subjects with new onset of the significant symptoms of rectal bleeding, abdominal pain, and a change in bowel habit consulted their GP. CONCLUSION: Lower gastrointestinal symptoms are common in a British elderly population and an important reason for GP consultation.     

Patients' involvement in decisions about medicines: GPs' perceptions of their preferences.

BACKGROUND: Patients vary in their desire to be involved in decisions about their care. AIM: To assess the accuracy and impact of GPs' perceptions of their patients' desire for involvement. DESIGN OF STUDY: Consultation-based study. SETTING: Five primary care centres in south London. METHOD: Consecutive patients completed decision-making preference questionnaires before and after consultation. Eighteen GPs completed a questionnaire at the beginning of the study and reported their perceptions of patients' preferences after each consultation. Patients' satisfaction was assessed using the Medical Interview Satisfaction Scale. Analyses were conducted in 190 patient-GP pairs that identified the same medicine decision about the same main health problem. RESULTS: A total of 479 patients participated (75.7% of those approached). Thirty-nine per cent of these patients wanted their GPs to share the decision, 45% wanted the GP to be the main (28%) or only (17%) decision maker regarding their care, and 16% wanted to be the main (14%) or only (2%) decision maker themselves. GPs accurately assessed patients' preferences in 32% of the consultations studied, overestimated patients' preferences for involvement in 45%, and underestimated them in 23% of consultations studied. Factors protective against GPs underestimating patients' preferences were: patients preferring the GP to make the decision (odds ratio [OR] 0.2 per point on the five-point scale; 95% confidence interval [CI] = 0.1 to 0.4), and the patient having discussed their main health problem before (OR 0.3; 95% CI = 0.1 to 0.9). Patients' educational attainment was independently associated with GPs underestimation of preferences. CONCLUSION: GPs' perceptions of their patients' desire to be involved in decisions about medicines are inaccurate in most cases. Doctors are more likely to underestimate patients' preferred level of involvement when patients have not consulted about their condition before.