全科医生在诊疗过程中的沟通行为与诊断有关吗？一项在六个欧洲国家开展的横断面研究。

Is the communicative behavior of GPs during the consultation related to the diagnosis? A cross-sectional study in six European countries.

作者信息

Deveugele Myriam, Derese Anselm, De Bacquer Dirk, van den Brink-Muinen Atie, Bensing Jozien, De Maeseneer Jan

机构信息

Department of General Practice and Primary Health Care, Ghent University, UZ 1K3 De Pintelaan 185, B 9000 Gent, Belgium.

出版信息

Patient Educ Couns. 2004 Sep;54(3):283-9. doi: 10.1016/j.pec.2004.02.004.

DOI:10.1016/j.pec.2004.02.004

PMID:15324979

Abstract

This study explores the relation between the diagnosis made by the general practitioner (GP) and his or her communicative behavior within a consultation, by means of the analysis of 2095 videotaped consultations of 168 GPs from six countries participating in the Eurocommunication study. The doctors' diagnoses were coded into ICPC chapters and merged into seven clinically relevant diagnostic clusters. The communicative behavior was gauged by means of the Roter interaction analysis system (RIAS). We found the most important differences for consultations about psychosocial problems as compared to all other diagnostic categories. In these consultations, doctors show more affective behavior, are more concerned about having a good relationship with their patients, ask more questions and give less information than in other consultations. The percentages of utterances in the other diagnostic categories were pretty similar. The communicative behavior of doctors reflects a global pattern in every consultation. This pattern is the most stable for affective behavior (social talk, agreement, rapport building and facilitation). Within instrumental behavior (the other categories), the directions and the information the doctor gives are adapted to the problems presented.

摘要

本研究通过对来自六个国家的168名全科医生（GP）参与欧洲交流研究的2095次视频会诊进行分析，探讨全科医生做出的诊断与其在会诊中的沟通行为之间的关系。医生的诊断被编码到国际初级保健分类（ICPC）章节中，并合并为七个临床相关的诊断类别。沟通行为通过罗特互动分析系统（RIAS）进行衡量。我们发现，与所有其他诊断类别相比，关于心理社会问题的会诊存在最重要的差异。在这些会诊中，医生表现出更多的情感行为，更关注与患者建立良好关系，比其他会诊问更多问题且提供更少信息。其他诊断类别的话语百分比相当相似。医生的沟通行为在每次会诊中都反映出一种总体模式。这种模式在情感行为（社交谈话、认同、建立融洽关系和促进交流）方面最为稳定。在工具性行为（其他类别）中，医生给出的指示和信息会根据所呈现的问题进行调整。