General practitioners' background knowledge of their patients

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Abstract
The aim of the study was to describe the background knowledge of their patients used by general practitioners in decision making in the consultation. Tape-recorded interviews with 22 general practitioners randomly selected from one FHSA, concerning 198 consultations, were used. General practitioners were asked to describe their background knowledge of the first ten patients seen that day, and to describe how their management decisions were influenced by this information. The interviews were analysed from transcripts. All except one doctor appeared to identify patients as ‘copers’ or ‘non-copers’. Decisions which appeared to be linked with coping were: (1) expecting them to have a physical illness; (2) offering reassurance, expecting that to be effective; (3) deciding that there was no need to take action; (4) allowing the patient to decide on some aspect of management. Decisions linked with not coping were: (1) to look for a psychological diagnosis; (2) to offer reassurance, but expecting that not to be effective; (3) to examine or refer because of the doctor's perception of the patient's ex tions. General practitioners also appeared to make decisions based on their perception of their patients' social support. If there was thought to be adequate support, or no social stress, the doctors decided (1) to look for a physical diagnosis; (2) to leave some decisions to the patient; (3) not to involve outside agencies in management; and (4) to ignore those areas of the patient's life which were thought not to be a problem. If doctors believed that there were problems with support, they seemed to try to give more of their time, and to refer or investigate more. Doctors were often aware of their feelings towards their patients, and of their patients' feelings for them, and both were usually positive. Positive feelings seemed to be linked with decisions (1) to increase the doctor's availability to the patient, and (2) to refer the patient in order to maintain the relationship. This study has introduced the concept that a random sample of general practitioners evaluate their patients as copers or non-copers and that this influences their management decisions in daily practice.

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