Armstrong D, Glanville T, Bailey E, O'Keefe G
Department of General Practice, UMDS, Guy's Hospital, London.
Br J Gen Pract. 1990 Jun;40(335):241-2.
It has been suggested that general practitioners have the potential to regulate a large percentage of their workload through their control of 'doctor-initiated' consultations. A survey was made of 300 consecutive consultations in a group practice. After their consultation patients completed a questionnaire asking what advice the doctor had given them on the need to reattend. At the same time the general practitioner completed a similar questionnaire about the need for reattendance and the advice given. The general practitioners judged that 74% of patients definitely or possibly needed to reattend, and only 26% definitely did not need to reattend. The coefficient of agreement between patients' and doctors' views on whether reattendance had been recommended was only 0.41. Thus the room for control of doctor-initiated consultations is limited by both clinical considerations and the apparent difficulty of accurately communicating the doctor's advice on reattendance to the patient.
有人认为，全科医生有可能通过控制“医生发起的”会诊来调节很大一部分工作量。对一个团体诊所的300次连续会诊进行了调查。会诊后，患者填写了一份问卷，询问医生就复诊必要性给了他们什么建议。与此同时，全科医生填写了一份关于复诊必要性及所给建议的类似问卷。全科医生判断，74%的患者肯定或可能需要复诊，只有26%的患者肯定不需要复诊。患者和医生对于是否建议复诊的意见一致性系数仅为0.41。因此，临床考量以及向患者准确传达医生关于复诊的建议所明显存在的困难，都限制了医生发起的会诊的可控空间。
