Ten established general practitioners, eight of whom were also trainers, took part in a course designed to improve their psychiatric interviewing skills. Participants were instructed in the problem-based model with audiotape and videotape feedback of real consultations in a group setting. Although those attending were experienced practitioners with a particular interest in the management of psychological problems, evaluation demonstrated a significant improvement in their skills after training. It is suggested that trainers could be trained to provide a similar teaching experience for their own trainees.
In the last few decades the emphasis in health care has shifted from acute to chronic diseases, from instrumental interventions to lifestyle related health promotion, from cure to care, and from doctor-centred to patient-centred behaviour. In all these respects, doctorpatient communication has become even more important and the need for good communication skills will only increase. Communication is crucial, because discovering the true nature of a patient's health problem, the translation into a diagnosis and the physician's treatment depend on good doctor-patient communication. This communication is carried out through an exchange of verbal and non-verbal information. The position of general practitioners is stronger in some countries than in others according to the part they play in the health care system 23 . In countries where they act as gatekeepers to secondary care, patients see their general practitioners first even when they require specialist services. A fixed patient list encourages general practitioners to take personal responsibility for the medical problems of their registered patients. The employment status of general practitioners is also closely associated with the structure of the health care system.In most West-European countries general practitioners are predominantly self-employed.Differences in structure reflect important cultural values, as people have strong, often positive, feelings about their health care system. 22 But at the same time differences in structure have important economic consequences; countries with a primary care-based structure have more cost-effective services.
24The main objective of the study was to investigate how the characteristics of various health care systems affect doctor-patient communication in general practice. This objective is consistent with the need for research on the efficiency and quality of health care delivery.
The gatekeeping role of GPs is hardly important in explaining doctor-patient communication. The relationship is more complex than expected. Patient and GP characteristics are more important. Cultural factors should be included in future studies.
Group teaching in problem-based interviewing based on video and audiotape feedback of the doctor's own consultations significantly improved the ability of experienced general practitioners to teach psychiatric skills to their trainees. When the GPs were randomly allocated to one of three further training experiences--video feedback of their tutorial sessions, discussion about how to teach and no further teaching, there were very few differences between the groups. The greatest impact on improving teaching skills was brought about by watching their own consultations in a group feedback setting.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.