How do GPs discuss subjects other than illness? Formulating and evaluating a theoretical model to explain successful and less successful approaches to discussing psychosocial issues.

Abstract

A theoretical model was formed, according to grounded theory, to understand how discussions about psychosocial problems might be designed. It was used in 19 videotaped consultations where it was considered relevant for the physician to take up psychosocial issues. 'Concern' i.e. that the patient could express that which was most pressing, was used as an indicator of outcome. A uniform pattern was observed in those cases where the patients expressed 'concern', in that the physician encouraged the patient by using open-ended questions, by following up the information received, and by having an empathic approach. On the other hand, in consultations where 'concern' was not expressed, it was noticed that the physician often asked close-ended, leading or negative questions, thus putting an end to the dialogue and, as a consequence, to the follow-up phase. Important therapeutic skills would appear to be the ability to reassure and support the patient as well as to be able to explain the connection between the patient's symptoms and psychosocial problems, rather than to solve these problems.