Objectives: To find how often social problems influence clinical management in general practice, how management is changed, and how the characteristics of patients, doctors, and the doctor-patient relationship influence this management.
Design: Multipractice survey of patients consulting general practitioners. Doctors completed a questionnaire for each patient.
Setting: General practices in Buskerud county, Norway.
Subjects: 1401 consecutive adult patients attending 89 general practitioners.
Main outcome measures: How often management of patients was influenced by different types of social problem and main reasons for consultation; frequency and intercorrelation of different types of management applied; odds ratios for social problems’ influence on management, controlled for by characteristics of doctors, patients, and their relationship.
Results: In 17% of all consultations the doctors’ knowledge of patients’ social problems influenced their management, stressful working conditions being the most frequent influencing type of problem. Knowledge of social problems influenced management more often when the doctor knew a patient well, but less often the longer a doctor had worked in a practice. When social problems influenced management, the commonest types of management offered were extra time for consultation (51%), advice (42%), authorisation of sick leave (28%), and prescription of a psychotropic drug (20%), while referral to community services was used in 2.6% of these consultations. Prescription of a psychotropic drug was positively correlated with use of extra time, and was made more often by female doctors.
Conclusions: Patients’ social problems influenced choice of management in at least a sixth of consultations. Prior knowledge of the patient, the doctor’s time in present practice, age and sex of the patient, and sex of the doctor significantly influenced management of patients.
Key messages We studied how patients’ social problems influenced their general practitioners’ management decisions In a sixth of consultations the doctors’ knowledge of social problems influenced management Extra time, advice, certifying a sick leave, and prescribing a psychotropic drug were the most common actions taken, while referral to other community services was seldom used Management was more often influenced by social problems if the doctor was recently established in the present practice or if the patient was well known to the doctor When influenced by social problems, female doctors prescribed a psychotropic drug three times as often as male doctors