Information-giving sequences in general practice consultations

Most patients want to be involved in the decision-making process regarding their health and doctors need to improve their ability to meet these needs. Before implementing educational interventions, a better understanding of how information is provided in routine clinical practice is necessary. Aim of this study was to analyse the information-giving sequence of general practice consultations.

This is an observational study that involved six general practitioners (GPs) in single-handed practices and patients (aged between 16 and 74) who consulted over a 2-month period for a new illness episode. Transcripts of 252 consultations were coded using the Verona Medical Interview Classification System that provides three categories for information giving (information on illness management; instructions on illness management and information and instructions on psychosocial aspects). Lag1 and lag2 sequential analyses were performed.

Information represented about one-third of the average consultation length. Medical and psychosocial information were preceded most often by patients' replies to previous questions (36% and 41%, respectively) and by listening and agreement (21% and 23%, respectively), less frequently by expression of opinions (10% and 6%, respectively). Listening and agreement were the most likely patient response after information (36%). GPs rarely tried to find out patients' view before and after the delivery of information or an instruction (<1%).

The low frequency of expressions of opinions and questions immediately before and after GPs' information and instructions, and the lack of facilitating questions indicate a limited degree of patient involvement in the information-giving sequence.