Howie J G, Porter A M, Forbes J F
Department of General Practice, University of Edinburgh.
BMJ. 1989 Apr 15;298(6679):1008-10. doi: 10.1136/bmj.298.6679.1008.
To examine the association between different consulting styles in general practice (defined according to the average length of doctor-patient contact time in surgery consultations) and the process of care for those patients presenting with new episodes of respiratory illness, 1787 consultations conducted by 85 general practitioner principals in Lothian from November 1987 to May 1988 were analysed. Short as against long consultations resulted in less attention being given to psychosocial issues that the doctor recognised as relevant. When psychosocial problems were dealt with prescribing of antibiotics decreased. In this volunteer sample of doctors the process of care seemed to reflect decisions as to how time was allocated rather than inherently different patterns of clinical behavior. Organisational and contractual changes will shift the mix of financial and professional incentives for general practitioners in ways that could lead to doctors reallocating their time toward shorter consultations; such a reallocation could have important implications for patient care.
为研究全科医疗中不同咨询方式（根据手术咨询中医患接触时间的平均长度定义）与呼吸系统疾病新发病例患者的护理过程之间的关联，对1987年11月至1988年5月期间洛锡安地区85位全科医生负责人进行的1787次咨询进行了分析。与长时间咨询相比，短时间咨询导致医生对其认为相关的社会心理问题关注较少。当处理社会心理问题时，抗生素的处方量会减少。在这个医生志愿者样本中，护理过程似乎反映了关于时间分配的决策，而不是本质上不同的临床行为模式。组织和合同方面的变化将以可能导致医生将时间重新分配到更短咨询的方式改变全科医生的经济和职业激励组合；这种重新分配可能对患者护理产生重要影响。
