Why patients consult and what happens when they do.

OBJECTIVE

To study patients' perceptions of why they consulted the doctor, how ill they thought they were, and what happened in the consultation. To compare patients' perceptions before and after the consultation and to compare these perceptions with those of the doctor.

DESIGN

Patients filled in a questionnaire before and after the consultation. The doctor filled a questionnaire in after the consultation.

SETTING

Three general practices in Bedfordshire and one in Hertfordshire.

PATIENTS

500 consecutive patients consulting in each practice.

MAIN OUTCOME MEASURES

Changes in patients' perceptions and differences between the perceptions of patients and doctors.

RESULTS

Doctors perceived patients to be less ill than the patients themselves did. Patients from social classes IV and V and children perceived themselves to be more ill than the average. Patients perceived themselves to be less ill after the consultation. A third of patients attended because doctors had told them to, and a quarter of patients had already tried to treat their problem themselves when they attended the consultation. Doctors' perceptions of the consultation emphasised listening, supporting, and giving advice. Patients' perceptions emphasised prescribing, reassuring, and referring to a consultant. Doctors perceived that they listened, examined, and gave advice less to social classes IV and V than to social classes I, II, and III and gave explanations more often to men than to women. Patients perceived external factors rather than lifestyle factors as being more important in causing their problems.

CONCLUSION

Doctors' perceptions of patients' problems differed from those of patients expressed both before and after their consultation. Doctors' and patients' perceptions also differed about the consultation itself. The consultation reassured some patients.