Doctor-initiated consultations: a study of communication between general practitioners and patients about the need...

It has been suggested that general practitioners have the potential to regulate a large percentage of their workload through their control of 'doctor-initiated' consultations. A survey was made of 300 consecutive consultations in a group practice. After their consultation patients completed a questionnaire asking what advice the doctor had given them on the need to reattend. At the same time the general practitioner completed a similar questionnaire about the need for reattendance and the advice given. The general practitioners judged that 74% of patients definitely or possibly needed to reattend, and only 26% definitely did not need to reattend. The coefficient of agreement between patients' and doctors' views on whether reattendance had been recommended was only 0.41. Thus the room for control of doctor-initiated consultations is limited by both clinical considerations and the apparent difficulty of accurately communicating the doctor's advice on reattendance to the patient.