Some methodological problems in studying consultations in general practice.

Every year in England and Wales there are about 200 million consultations between patients and general practitioners. Yet knowledge about these consultations is uneven and, in many aspects, scanty. There are statistics about the numbers, cost, and content of the prescriptions that are made up as a result of these consultations. The survey of the Royal College of General Practitioners, Office of Population Censuses and Surveys, and the Department of Health and Social Security selected practices and collected and published data on consultation rates by age and sex, episodes of illness, diagnosis, referrals, and home visits. Other studies have looked at appointment systems, practice organisation, the employment of ancillary staff, premises and equipment, the use of diagnostic facilities, transport, and the time spent on different tasks. In addition to epidemiological studies and studies of management, research workers have looked at communications between doctors and patients. They have tended to concentrate on how much patients recall and follow the advice and treatment prescribed by the doctor. There has been little intensive study of the nature of consultations and of patients' and doctors' perceptions of them. Two such recent studies have looked at the way in which doctors talk to patients (Long, 1974), and at the consultation process in general practice (Stimson and Webb, 1975). If the basic aim of general practice is to give primary personal care then one of the yardsticks for measuring its success is surely the extent to which doctors are aware of their patients' problems, and the degree to which patients communicate their needs to their doctors. One study by Williamson et al. (1964) sug¬ gested that many elderly patients had difficulties of which their doctors were unaware, although the problems might be relieved by medical intervention. If we are to understand the reasons why doctors may remain ignorant of potentially treatable conditions in their patients, we need to look at consultations from the viewpoint of both patients and doctors to find out about the expectations, hopes and fears that are expressed, suppressed, or changed and about the ways in which these different outcomes arise. Aims of the study This was a feasibility study. It aimed to develop techniques to describe and analyse communications at doctor-patient contacts. Specifically we were concerned to develop measures of how much: (1) Patients communicate their perceived needs to the doctor, (2) Patients are aware that doctors recognise or do not recognise …