What do patients bring up in consultations? An observational study in general practice

Objective. The main aim of the study was to investigate how many and what kind of problems patients present in consultations with their general practitioner (GP). A secondary aim was to explore patients’ views on what is important in consultations. Design. Cross-sectional study including observation of unselected consultations with recording on a pre-designed scheme, and a brief questionnaire filled in by patients. Setting. Four general practices in Oslo, Norway. Subjects. A total of 201 patients in consultations and 177 patients waiting to see their GP. Main outcome measures. Number and characteristics of problems raised by patients, and whether the problems were handled by GPs during the ongoing consultation. Patients’ expectations for the consultation. Results. The mean number of problems raised was 2.6 (range 1–16), and when appointments for acute conditions were excluded, the mean number was 3.3. Somatic problems comprised about half of all problems, and in more than one-quarter of consultations a mental health issue was presented. Female sex and increasing age predicted an increasing number of problems raised. In one-quarter of encounters four or more problems were presented. The vast majority of problems were dealt with by the GPs during the ongoing consultation. “That I am able to address all the problems I have” was rated as highly important by patients. Conclusion. GPs deal with multiple and unrelated problems in daily consultations, which is highly valued by patients. Management of concurrent problems in brief encounters demands training and adequate working conditions, in order to sustain this core value of general practice

Hva kan jeg hjelpe deg med? En studie fra 201 observasjoner av konsultasjoner i allmennpraksis

Background There has been done few studies on the subject of the complexity of consultations i a general practitioner s office. Some have done research on the number of problems adressed during a concultation. There has however been little research done on the nature of the problems adressed. Objective The purpose of this study was to describe the complexity of the problems raised at a GP s office. We also wanted to examine what patients regard as the most important factor when they go to see their GP. Methods This is a cross-sectional study, which involves observations of consultations in general practice. We registered the number of problems adressed, the nature of the problems, who intitiated to talk about the problem and if handling of the problem was postponed. We also used questionnaires to ask patients what they found to be most important when seeing their GP. Results We observed 201 consultations. On average, 2,6 problems were observed during an encounter. In almost one fourth of the consultations, more than three problem were adressed. At least one psychic problem was raised in over one fourth of the consultations. Females raised more problems compared to men. There was also a positive relationship between age and number of problems addressed. We collected 177 answered questionnaires. Patients regard it as most important to be able to talk about all their problems during a consultation. Conclusion It is common to address multiple problems during consultations at the GP s office. The problems are often not medically related. Patients regard it as important to talk about all their problems. This requires a unique competence of the GP. Our findings will have implications for future research on general practice and in the education of GPs