Zantinge Else M, Verhaak Peter F M, de Bakker Dinny H, Kerssens Jan J, van der Meer Klaas, Bensing Jozien M
NIVEL, Netherlands Institute for Health Services Research, Utrecht, The Netherlands.
Patient Educ Couns. 2007 Jul;67(1-2):93-9. doi: 10.1016/j.pec.2007.02.006. Epub 2007 Mar 26.
To investigate if general practitioners (GPs) with a higher workload are less inclined to encourage their patients to disclose psychological problems, and are less aware of their patients' psychological problems.
Data from 2095 videotaped consultations from a representative selection of 142 Dutch GPs were used. Multilevel regression analyses were performed with the GPs' awareness of the patient's psychological problems and their communication as outcome measures, the GPs' workload as a predictor, and GP and patient characteristics as confounders.
GPs' workload is not related to their awareness of psychological problems and hardly related to their communication, except for the finding that a GP with a subjective experience of a lack of time is less patient-centred. Showing eye contact or empathy and asking questions about psychological or social topics are associated with more awareness of patients' psychological problems.
Patients' feelings of distress are more important for GPs' communication and their awareness of patients' psychological problems than a long patient list or busy moment of the day. GPs who encourage the patient to disclose their psychological problems are more aware of psychological problems.
We recommend that attention is given to all the communication skills required to discuss psychological problems, both in the consulting room and in GPs' training. Additionally, attention for gender differences and stress management is recommended in GPs' training.
调查工作量较大的全科医生是否不太倾向于鼓励患者披露心理问题,以及对患者的心理问题了解较少。
使用了来自142名荷兰全科医生的代表性样本的2095次录像会诊数据。采用多水平回归分析,以全科医生对患者心理问题的认知及其沟通情况作为结果指标,以全科医生的工作量作为预测因素,并将全科医生和患者的特征作为混杂因素。
全科医生的工作量与他们对心理问题的认知无关,并且除了发现主观感觉时间不足的全科医生以患者为中心的程度较低外,工作量与他们的沟通几乎无关。进行眼神交流或表达同理心以及询问有关心理或社会话题的问题与对患者心理问题的更多认知相关。
对于全科医生的沟通以及他们对患者心理问题的认知而言,患者的痛苦感受比长长的患者名单或一天中的忙碌时刻更为重要。鼓励患者披露心理问题的全科医生对心理问题的认知更强。
我们建议在诊室和全科医生培训中都要关注讨论心理问题所需的所有沟通技巧。此外,建议在全科医生培训中关注性别差异和压力管理。