Process and outcomes in general practice consultations: problems in defining high quality care

In order to explore the relationships between the verbal interactions of the consultation and several outcomes (patient health change, patient compliance and the satisfaction of both doctor and patient), 21 General Practitioners contributed ten audiotaped consultations each, from consecutive consenting adult patients. The effects of GP sex and postgraduate training were also investigated, but were found to be minimal. Patient health change was most clearly related to acuteness of symptoms at presentation, whereas reported compliance was predicted by patient satisfaction after the consultation. Different consultations were maximally satisfying for doctors and for patients, and patient and doctor satisfaction with specific consultations showed little correlation. This result implies that the measurement of quality of care, in general practice at least, is a more complex task than has been assumed, and in turn raises issues about whose definition of outcome is relevant in discussing quality of care.