Open AccessObserving decision‐making in the general practice consultation: who makes which decisions?
Author(s) -
Ford Sarah,
Schofield Theo,
Hope Tony
Publication year - 2006
Publication title -
health expectations
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.314
H-Index - 74
eISSN - 1369-7625
pISSN - 1369-6513
DOI - 10.1111/j.1369-7625.2006.00382.x
Subject(s) - perception , medical decision making , primary care , general practice , family medicine , medicine , scale (ratio) , rating scale , clinical decision making , psychology , nursing , developmental psychology , physics , quantum mechanics , neuroscience
Objective To investigate opportunities for, and types of decision making in the general practice (primary care) consultation, and examine differences in skills of those doctors who are successful at meeting their patients’ preferences and those who are less successful. Design Observation study of doctor–patient consultations in general practice. Participants Patients attending for routine appointments in 12 general practice surgeries across Oxfordshire. Methods A total of 212 doctor–patient consultations were video‐recorded. The patients involved completed a questionnaire to elicit their perceptions of how decisions were made. The video‐taped recordings were coded with a new instrument, the Evidence Based Patient Choice Instrument (EBPCI), to classify the number and type of decision‐making opportunities arising during each consultation. A total of 149 recordings were coded using the Oxbridge Rating Scale to assess the doctors’ consultation styles. Results There was a range of decision‐making opportunities in addition to those involving medical treatment. With the exception of ‘fitness for work’, decisions were generally ‘doctor led’. There was only moderate agreement between patient perceptions of their level of involvement in decision making and the objective ratings using the EBPCI. There was wide variation in the ability of doctors to meet their patients’ preferences for involvement. Conclusions There are many decisions made in primary care consultations, in addition to those about medical treatments, in which patients could be involved to a greater extent than they currently are. Some doctors are significantly better than others at meeting different patients’ preferences for their decision‐making role. Patients’ perceptions of shared decision making appears to be influenced by the doctors’ general consultation skills.