Information‐giving sequences in general practice consultations

Rationale, aims and objective  Most patients want to be involved in the decision‐making process regarding their health and doctors need to improve their ability to meet these needs. Before implementing educational interventions, a better understanding of how information is provided in routine clinical practice is necessary. Aim of this study was to analyse the information‐giving sequence of general practice consultations. Methods  This is an observational study that involved six general practitioners (GPs) in single‐handed practices and patients (aged between 16 and 74) who consulted over a 2‐month period for a new illness episode. Transcripts of 252 consultations were coded using the Verona Medical Interview Classification System that provides three categories for information giving (information on illness management; instructions on illness management and information and instructions on psychosocial aspects). Lag1 and lag2 sequential analyses were performed. Results  Information represented about one‐third of the average consultation length. Medical and psychosocial information were preceded most often by patients’ replies to previous questions (36% and 41%, respectively) and by listening and agreement (21% and 23%, respectively), less frequently by expression of opinions (10% and 6%, respectively). Listening and agreement were the most likely patient response after information (36%). GPs rarely tried to find out patients’ view before and after the delivery of information or an instruction (<1%). Conclusion  The low frequency of expressions of opinions and questions immediately before and after GPs’ information and instructions, and the lack of facilitating questions indicate a limited degree of patient involvement in the information‐giving sequence.