Attitudes to medical care, the organization of work, and stress among general practitioners.

Eighty five volunteer general practitioners in Lothian region recorded clinical and contextual information on 21,000 consultations during 1987-88. During their recording sessions they reported their perceived levels of stress using a previously validated scale. Subsequently, 80 of the doctors completed a previously validated multi-dimensional scale about their attitudes to patient care. Three attitude subscales (psychological orientation, appropriateness of consultations and responsibility for decisions) correlated with processes of care previously identified as indicators of good care. The 20 doctors who scored most highly on these patient-centred scales recorded self-perceived stress in 27% of their consultations compared with 11% of the consultations of the 33 doctors who scored lowest on these scales. Among the 20 most patient-centred doctors those booking patients at eight patients per hour or more reported stress at twice as many consultations as those with a longer booking interval; doctors whose preferred working styles conflicted with their booking patterns reported stress in up to 62% of consultations. Doctors with a higher patient-centred orientation find their work more stressful. Longer booking intervals remove much of that stress, particularly when doctors' preferred style of consulting requires them to spend more time at individual consultations. Previously described work stressors offer a theoretical explanation for a problem which is important for both doctors and patients.