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2.  Eliciting patients' concerns: a randomised controlled trial of different approaches by the doctor 
Background: Although a ‘patient-centred’ approach to general practice consultation is widely advocated, there is mixed evidence of its benefits.
Aim: To measure the costs and benefits of using a prompt to elicit patients' concerns when they consult for minor illness.
Design of study: An open randomised controlled trial.
Setting: Four training semi-rural general practices in the south-east of the United Kingdom.
Method: Patients identified during the first part of the consultation as having a self-limiting illness were randomised to a second part of the consultation that was conducted ‘as usual’ or involved a written prompt to elicit the patient's concerns. After each consultation the doctor noted the diagnosis and the consultation length and the patient self-completed a questionnaire containing measures of satisfaction, enablement and anxiety.
Results: One hundred and ten patients were studied. Patients in the elicitation group reported a small but significant increase in the ‘professional care’ score of the consultation satisfaction questionnaire (88.2 versus 80.9, mean difference = 7.3, 95% confidence interval = 2.0 to 12.6) but no other benefits were detected. Consultations in the elicitation group, however, were longer by about a minute.
Conclusion: Given the pressures on consultation time in general practice there must be questions about the practical value of eliciting patients' concerns if the benefit of doing so is small and the cost large.
PMCID: PMC1326066  PMID: 15353051
consultation; general practice; patient concern; patient satisfaction; self-limiting illness; time
3.  What constructs do GPs use when diagnosing psychological problems? 
Background: The mismatch between general practice and psychiatric diagnosis of psychological problems has been frequently reported.
Aims: To identify which items from the 28-item general health questionnaire (GHQ-28) best predicted general practitioners' (GPs') own assessments of morbidity and the proportion of time spent in consultations on psychological problems.
Design of study: Cross-sectional survey.
Setting: General practice in southeast London.
Method: Eight hundred and five consultations were carried out by 47 GPs, during which patients completed the 28-item GHQ, and doctors independently assessed the degree of psychological disturbance and the proportion of the consultation spent on psychological problems. Data from the consultations were entered into a stepwise multiple regression to determine the best GHQ item predictors of GP judgements.
Results: GPs' assessments of the degree of psychological disturbance were best predicted using only seven GHQ items, and their perceptions of the proportion of time spent on psychological problems were predicted by only four items. Items were drawn predominantly from the ‘anxiety and insomnia’ and ‘severe depression’ sub-scales, ignoring the ‘somatic’ and ‘social dysfunction’ dimensions.
Conclusion: In diagnosing psychological disturbance GPs ignore major symptom areas that psychiatrists judge important.
PMCID: PMC1324836  PMID: 15296555
consultation; mental disorders; psychiatric diagnosis; questionnaire
4.  General practitioners' perceptions of sharing workload in group practices: qualitative study 
BMJ : British Medical Journal  2004;329(7462):381.
Objective To explore general practitioners' beliefs and experiences of distribution of workload and teamwork between doctors in general practice.
Design Qualitative semistructured interview study.
Setting South London.
Participants 18 general practitioners from 11 practices.
Main outcome measures Perceptions and experiences of distribution of workload and teamwork between doctors.
Results Equitable distribution of workload was a common concern among general practitioners in group practices. Several ways of addressing the problem were identified, including relying on trust, creating systems of working based on explicit rules such as points' systems, and improving communication. Improvement of communication was hampered by the taboo nature of the problem.
Conclusion Resentment about perceived inequalities in workload places a further burden on general practices. The issue of working together warrants further support.
doi:10.1136/bmj.38173.532465.7C
PMCID: PMC509345  PMID: 15265814

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