Objective To measure patients' perceptions of patient centredness and the relation of these perceptions to outcomes. Design Observational study using questionnaires. Setting Three general practices. Participants 865 consecutive patients attending the practices. Main outcome measures Patients' enablement, satisfaction, and burden of symptoms. Results Factor analysis identified five components. These were communication and partnership (a sympathetic doctor interested in patients' worries and expectations and who discusses and agrees the problem and treatment, Cronbach's = 0.96); personal relationship (a doctor who knows the patient and their emotional needs, = 0.89); health promotion ( = 0.87); positive approach (being definite about the problem and when it would settle, = 0.84); and interest in effect on patient's life ( = 0.89). Satisfaction was related to communication and partnership (adjusted = 19.1; 95% confidence interval 17.7 to 20.7) and a positive approach (4.28; 2.96 to 5.60). Enablement was greater with interest in the effect on life (0.55; 0.25 to 0.86), health promotion (0.57; 0.30 to 0.85), and a positive approach (0.82; 0.52 to 1.11). A positive approach was also associated with reduced symptom burden at one month ( = − 0.25; − 0.41 to − 0.10). Referrals were fewer if patients felt they had a personal relationship with their doctor (odds ratio 0.70; 0.54 to 0.90). Conclusions Components of patients' perceptions can be measured reliably and predict different outcomes. If doctors don't provide a positive, patient centred approach patients will be less satisfied, less enabled, and may have greater symptom burden and higher rates of referral.

Objective: To assess three prescribing strategies for sore throat.

Objective To compare immediate with delayed prescribing of antibiotics for acute otitis media.

Objective: To assess the medicalising effect of prescribing antibiotics for sore throat. Setting: 11 general practices in England.

Objectives To identify which children with acute otitis media are at risk of poor outcome and to assess benefit from antibiotics in these children.

Sore throat is one of the commonest reasons for visiting general practitioners yet little is known about what factors are important in its natural course. This is important since people with prolonged illness after the consultation-the 36% with illness lasting more than five days after seeing the doctor (the median)-are much more likely to reattend.1 Providing patients with information about duration of illness can reduce expectation and reattendance. 2 We studied factors that affect duration of sore throat and assessed whether satisfaction with the consultation independently predicts duration of illness. Participants, methods, and resultsThe methods are reported in full elsewhere.3 General practitioners documented the clinical characteristics of 716 patients presenting with sore throat, who were then randomised to one of three prescribing strategies (antibiotics, no antibiotics, delayed antibiotics). Patients recorded satisfaction with the consultation and how well their concerns had been dealt with on four point Likert scales (very, moderately, slightly, not at all) after the consultation and kept a diary of symptoms until better. Resolution of symptoms was documented by 579 patients (81%).3 The Likert scales showed good test-retest reliability.3 In 75 consecutive attenders Likert scales on satisfaction and dealing with concerns both demonstrated criterion validity: rank correlations with previously validated scales of the medical interview satisfaction scale questionnaire 4 were 0.56 and 0.58 for overall satisfaction and 0.63 and 0.61 for the distress-relief subscale.Given that 36% of subjects had prolonged illness, we calculated that a total of 517 participants were required to have 80% power and 95% confidence to detect odds ratios of either 0.5 or 2.0 for prolonged illness with dichotomous variables with prevalences of 25%-75% using epi info. We assessed the predictive value of variables using logistic regression models by forward selection using stata software; variables were retained if they remained significant (5% level).Older patients (over 12 years), those with longer duration of illness before consultation, those with cough, and those who were less satisfied were more likely to have prolonged course (table). Shorter duration of illness before seeing the doctor was more likely with higher temperature ( > 37.5°C; odds ratio 3.2, 95% confidence interval 1.9 to 5.5) and with the presence of three out of five of a defined complex of symptoms and signs (2.5; 1.5 to 4.2).3 Most people (69%) had their concerns very well dealt with; this was a better predictor of whether patients were very satisfied (odds ratio 88.6; 38.4 to 177.4) than whether

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