Requesting care in a medical encounter: How patients make requests and how general practitioners respond.

OBJECTIVES: General practitioners (GPs) often deal with patient requests, yet little is known about the types of requests and how GPs respond. We used real-life Dutch consultations (recorded in 2015) to identify how care is requested in clinical practice. METHODS: We analysed sixty-six consultations using an inductively and deductively developed codebook. Coders categorised five items of patient requests: type, speaker, formulation, GP response, and resolution. Correlations between these items were analysed with chi-square analyses. RESULTS: We identified 257 patient requests. Most requests concerned information or advice (n = 191, 74.3 %). When patients requested medical care, they often did so indirectly (χ2 (1)= 69.66, p < .001). Request type predicted the resolution: GPs were more likely to meet requests for information than for medical care (χ2(1) = 5.45, p = .019). More than half of the medical care requests that were followed by an explanation were not met (n = 5, 55.6 %). When a request was not met, GPs used communication strategies such as offering alternatives, referencing examination results, and depersonalisation. CONCLUSIONS: Asking questions, co-construction of a request, and explaining are important diagnostic and therapeutic tools for GPs in conversing with the patient. PRACTICE IMPLICATIONS: These conversational strategies could be trained to help GPs evaluate requests while maintaining a good GP-patient relationship.

Quantifying positive communication: Doctor's language and patient anxiety in primary care consultations.

OBJECTIVE: Positive communication is advocated for physicians during consultations with patients presenting medically unexplained symptoms (MUS), but studies generally focus on what is said rather than how it is said. This study quantified language use differences of general practitioners (GPs), and assessed their relation to patient anxiety. METHODS: Language use of 18 Dutch GPs during 82 consultations was compared for patients with MUS versus medically explained symptoms (MES). Message content (positive or negative) was differentiated from its directness (direct or indirect), and related to changes in patient's state anxiety (abbreviated State Trait Anxiety Inventory; STAI). RESULTS: In total, 2590 clauses were identified. GPs approached patients with MES with relatively more direct (vs. indirect) positive and indirect (vs. direct) negative messages (OR 1.91, 95% CI 1.42-2.59). Anxiety of both patient groups increased when GPs used more direct (vs. indirect) negative messages (b = 0.67, 95% CI 0.07-1.27) CONCLUSIONS: GPs use different language depending on the content of messages for patients with MES, but not MUS. Direct negative messages relate to an increase in patient anxiety. PRACTICE IMPLICATIONS: GPs could manage patient's state anxiety by expressing negative messages in an indirect rather than direct manner.