Bensing J
Netherlands Institute for Primary Health Care, Utrecht.
Soc Sci Med. 1991;32(11):1301-10. doi: 10.1016/0277-9536(91)90047-g.
In this article a comparison is made between three independent sources of assessment of medical consultations. A panel of 12 experienced general practitioners rated 103 consultations with hypertensive patients on the quality of psychosocial care. There was a wide consensus between the judges, resulting in a high reliability score. Two contrasting groups were formed: consultations that were rated high and those rated low in quality of psychosocial care. A comparison was made between this general assessment of the quality of psychosocial care and a more detailed assessment of the same consultations on nine much used communication variables made by trained psychologists. Knowledge about doctor-patient communication proved to predict very well as to which quality group the consultations belonged. A very high percentage (95%) was predicted accurately, solely on the basis of these nine communication variables. Affective behaviour, and especially nonverbal affective behaviour had the strongest predictive power. In the last part of the study a third source of assessment, i.e. patients' satisfaction was compared with both other sources. Much lower relationships were found, although most were in the predicted direction. Affective behavior seems to be the most important in determining patient's satisfaction. The implications of these findings are discussed.
本文对医学咨询评估的三个独立来源进行了比较。一个由12名经验丰富的全科医生组成的小组，对103次高血压患者的会诊进行了心理社会护理质量评估。评委之间达成了广泛共识，得出了较高的可靠性分数。形成了两个对比组：心理社会护理质量评分高的会诊和评分低的会诊。将这种心理社会护理质量的总体评估与训练有素的心理学家对相同会诊在九个常用沟通变量上进行的更详细评估进行了比较。事实证明，医患沟通知识能够很好地预测会诊所属的质量组。仅基于这九个沟通变量，就有非常高的比例（95%）被准确预测。情感行为，尤其是非言语情感行为具有最强的预测力。在研究的最后一部分，将第三种评估来源，即患者满意度，与其他两种来源进行了比较。虽然大多数关系与预测方向一致，但发现的相关性要低得多。情感行为似乎在决定患者满意度方面最为重要。本文讨论了这些发现的意义。
