Case recognition and interview utterances: effect of GHQ feedback

Eighty-four audiotaped clinical interviews of seven general practitioners (GPs) with high scoring patients on the General Health Questionnaire (GHQ-28) were analysed at baseline and compared with a similar number at feedback during which doctors were presented with the GHQ-28 scores of their patients. At feedback, there was a significant reduction in the use of physical utterances (deviance 35.150, df 1, P < 0.001), an increase in the use of directive questions, a reduction in closed questions, and more advice and more psychological utterances were made. The five doctors who improved had a mean rise in identification index (ID) of 0.25 +/- 0.12. Such benefit was more apparent among doctors with lower IDs at baseline. There was no significant correlation in the magnitude of rise in ID and change in psychological utterances. Most doctors were not aware of the impact of the GHQ on their interview technique and case recognition ability.