Winefield H R, Murrell T G, Clifford J
Department of Psychiatry, University of Adelaide, South Australia.
Soc Sci Med. 1995 Oct;41(7):969-75. doi: 10.1016/0277-9536(94)00403-g.
In order to explore the relationships between the verbal interactions of the consultation and several outcomes (patient health change, patient compliance and the satisfaction of both doctor and patient), 21 General Practitioners contributed ten audiotaped consultations each, from consecutive consenting adult patients. The effects of GP sex and postgraduate training were also investigated, but were found to be minimal. Patient health change was most clearly related to acuteness of symptoms at presentation, whereas reported compliance was predicted by patient satisfaction after the consultation. Different consultations were maximally satisfying for doctors and for patients, and patient and doctor satisfaction with specific consultations showed little correlation. This result implies that the measurement of quality of care, in general practice at least, is a more complex task than has been assumed, and in turn raises issues about whose definition of outcome is relevant in discussing quality of care.
为了探究会诊中的言语互动与若干结果（患者健康状况变化、患者依从性以及医患双方满意度）之间的关系，21名全科医生提供了各自连续10次与同意参与的成年患者进行会诊的录音。还调查了全科医生性别和研究生培训的影响，但发现其影响极小。患者健康状况变化与就诊时症状的急性程度最为明显相关，而报告的依从性则由会诊后患者满意度预测。不同的会诊对医生和患者的满意度最高，并且患者和医生对特定会诊的满意度相关性很小。这一结果意味着，至少在全科医疗中，医疗质量的衡量是一项比人们所设想的更为复杂的任务，进而引发了关于在讨论医疗质量时谁对结果的定义具有相关性的问题。
