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General-practitioner trainers in Scotland responded to a questionnaire on difficulties in consultation significantly more readily than did non-trainers. Their answers to some questions were significantly different.
Trainer and trainee views of difficulties in communication with different types of patients and situations are broadly similar. Because of this similarity of views, the experienced doctor can plan an approach to training which is valid for the inexperienced trainee. He may, however, modify his estimate of the degree of difficulty for the trainee of consultation by involving some categories, for example, adolescents (easier for the trainee), dying patients (more difficult), patients of socioeconomic status which is different to that of the doctor (more difficult).
Some aspects of the consultation merit special attention: techniques such as those appropriate to ending the interview and discovering the patient's reasons for seeking medical help.
While trainees' problems associated with lack of familiarity with patients and their circumstances are likely to decrease with time spent in the teaching practice, adequate records can help to diminish the trainees' insecurity.
This survey confirms the need to continue to focus attention on patient management as a component of training as relevant as the detailed diagnosis and treatment of disease.