Participation of patients during general practice consultations: comparison between trainees and experienced doctors

Consultations with 494 patients were tape-recorded, transcribed and coded. The sample consisted of 168 patients of six experienced general practitioners from training practices, and 326 patients of six trainee general practitioners. Talk in the consultations of trainees and experienced doctors was similar in many respects, including total quantity of talk per consultation. However, twice as many patients of the trainees than those of the experienced doctors produced questions and comments which followed from something already said by the doctor. In addition, the trainees were more likely than the experienced doctors to ask the patients questions about the suggested treatment, rather than simply to offer instructions and advice. These features of doctors' and patients' behaviour were significantly correlated with each other for both the trainees and the experienced doctors. It is suggested that the strategy of engaging patients in discussion about treatment, used more by the trainees, encouraged patients to think of queries which otherwise might not have occurred to them during the consultation.