Bensing Jozien M, Tromp Fred, van Dulmen Sandra, van den Brink-Muinen Atie, Verheul William, Schellevis François G
NIVEL, Netherlands Institute for Health Services Research, PO Box 1568, 3500 BN, Utrecht, The Netherlands.
BMC Fam Pract. 2006 Oct 25;7:62. doi: 10.1186/1471-2296-7-62.
Departing from the hypotheses that over the past decades patients have become more active participants and physicians have become more task-oriented, this study tries to identify shifts in GP and patient communication patterns between 1986 and 2002.
A repeated cross-sectional observation study was carried out in 1986 and 2002, using the same methodology. From two existing datasets of videotaped routine General Practice consultations, a selection was made of consultations with hypertension patients (102 in 1986; 108 in 2002). GP and patient communication was coded with RIAS (Roter Interaction Analysis System). The data were analysed, using multilevel techniques.
No gender or age differences were found between the patient groups in either study period. Contrary to expectations, patients were less active in recent consultations, talking less, asking fewer questions and showing less concerns or worries. GPs provided more medical information, but expressed also less often their concern about the patients' medical conditions. In addition, they were less involved in process-oriented behaviour and partnership building. Overall, these results suggest that consultations in 2002 were more task-oriented and businesslike than sixteen years earlier.
The existence of a more equal relationship in General Practice, with patients as active and critical consumers, is not reflected in this sample of hypertension patients. The most important shift that could be observed over the years was a shift towards a more businesslike, task-oriented GP communication pattern, reflecting the recent emphasis on evidence-based medicine and protocolized care. The entrance of the computer in the consultation room could play a role. Some concerns may be raised about the effectiveness of modern medicine in helping patients to voice their worries.
基于过去几十年患者已成为更积极的参与者且医生已变得更注重任务这一假设，本研究试图确定1986年至2002年间全科医生与患者沟通模式的转变。
1986年和2002年采用相同方法进行了重复横断面观察研究。从两个现有的常规全科医疗会诊录像数据集里，选取了高血压患者的会诊（1986年102例；2002年108例）。全科医生与患者的沟通采用RIAS（罗特互动分析系统）进行编码。使用多水平技术对数据进行分析。
在两个研究时间段的患者组中均未发现性别或年龄差异。与预期相反，近期会诊中患者活跃度较低，说话较少，提问更少，表现出的担忧也更少。全科医生提供了更多医疗信息，但对患者病情表达担忧的频率也更低。此外，他们较少参与以过程为导向的行为和建立伙伴关系。总体而言，这些结果表明2002年的会诊比16年前更注重任务且更具公事公办的性质。
在这个高血压患者样本中未体现出全科医疗中存在更平等的关系，即患者作为积极且挑剔的消费者的情况。多年来观察到的最重要转变是向更公事公办、注重任务的全科医生沟通模式转变，这反映了近期对循证医学和规范化护理的重视。电脑进入会诊室可能起到了一定作用。对于现代医学在帮助患者表达担忧方面的有效性可能会引发一些担忧。
