Prevention in practice. How do general practitioners discuss life-style issues with their patients?

Forty-six representative consultations in general practice were video recorded. Afterwards the patients and the GPs separately reviewed the recordings and gave their spontaneous comments. A hypothetical-deductive analysis, with a starting point in current health educations models, was carried out in order to characterize the health counselling discussions. Life-style issues (diet, exercise, smoking and alcohol) were discussed in 15 sequences in eight consultations. Four types of sequences were discerned: short advice by the physician (I), a short question by the patient (II), lengthy advice by the physician (III) and a patient-centred discussion (IV). Most health education constructs studied were identified in the type IV sequence but few in type I-III. In the short and the lengthy advice sequences there was a similar structure; the strategy to affect patients' life-style was condemnations of the patient behaviour and exhortations to change. No physician commented positively on these sequences. Appropriate training might improve life-style counselling in general practice through a patient-centred approach and with guidance from constructs in health education models.