Programme no. 126-OP
Addressing multiple problems during general practice consultations – A cross-sectional observational study
Mette Brekke*1, Elisabeth Bjørland2
1Department of General Practice,University of Oslo, Institute of Health and Society,0318 Oslo,Norway, 2Faculty of medicine,University of Oslo, Institute of Health and Society,0318 Oslo,Norway
* = Presenting author
Objectives: The aim of the present study was to shed some light into this “black box” in a Norwegian setting. Based upon own experience and literature studies, our hypotheses were that patients more often than not present several, unrelated problems in one single consultation, and that these are handled by the GP. Our secondary aim was to explore patients’ expectations in front of a consultation with their GP.
Background: The GP consultation has been called a “black box” because its contents have been little exposed.
Results: Mean number of problems raised in these 201 consultations was 2.6 (range 1 - 16), and when appointments for acute conditions were excluded, mean number was 3.3. In more than one fourth of consultations a mental health issue was presented. Female sex, increasing age and seeing own GP predicted an increasing number of problems presented. The vast majority of problems were dealt with by the GP during the ongoing consultation. “Being able to address all or most of my worries” was rated as highly important by patients when seeing their GP.
Material/Methods: We conducted a cross sectional observational study in four general practices in the city of Oslo in 2013. The second author, then a fourth year medical student, collected data during direct observation of 201 unselected consultations with four different GPs, by means of a pre-designed registration scheme. In addition to the registrations, 177 other unselected patients answered a questionnaire before entering a consultation with the same four GPs.
Conclusion: This is probably the first Scandinavian study exposing GP consultations through direct observations, focusing on the problems presented by patients. We found that the GPs were able to deal with several un-edited problems presented during a brief consultation. Doing this adequately demands a specific type of competence, more comprehensive and different from traditional knowledge about diseases and their treatment. Patients seem to put a high value on being able to address all their worries in the consultation.
Points for discussion: How can GPs meet their patients’ needs to address multiple problems in the consultation without burning out? What kind of specific competence does this demand, and how can this be learned?