Requesting care in a medical encounter: How patients make requests and how general practitioners respond.

Abstract

General practitioners (GPs) often deal with patient requests, yet little is known about the types of requests and how GPs respond. We used real-life Dutch consultations (recorded in 2015) to identify how care is requested in clinical practice. We analysed sixty-six consultations using an inductively and deductively developed codebook. Coders categorised five items of patient requests: type, speaker, formulation, GP response, and resolution. Correlations between these items were analysed with chi-square analyses. We identified 257 patient requests. Most requests concerned information or advice (n = 191, 74.3 %). When patients requested medical care, they often did so indirectly (χ² (1)= 69.66, p < .001). Request type predicted the resolution: GPs were more likely to meet requests for information than for medical care (χ²(1) = 5.45, p = .019). More than half of the medical care requests that were followed by an explanation were not met (n = 5, 55.6 %). When a request was not met, GPs used communication strategies such as offering alternatives, referencing examination results, and depersonalisation. Asking questions, co-construction of a request, and explaining are important diagnostic and therapeutic tools for GPs in conversing with the patient. These conversational strategies could be trained to help GPs evaluate requests while maintaining a good GP-patient relationship.