Dissatisfied patients: improving general practitioners' initial reactions.

General practitioners often have difficulty in dealing with dissatisfied patients. One underlying reason could be the disturbed relationship between the doctor and the dissatisfied patient. A training course has been developed taking the relationship as a starting-point. Based on Watzlawick et al.'s theory on communication GPs have been trained to react to a dissatisfied patient on a relational level ('Are you dissatisfied with my treatment?') rather than on a contents level ('How long have you been suffering from this?'). This method seeks to improve the relationship and the satisfaction of both doctor and patient. Three types of initial reaction to dissatisfied patients were offered to four groups of GPs (19 trainees in general practice and 19 trainers in general practice). Pre- and post-measurement were executed by means of registering the initial reactions on videorecorded vignettes of re-enacted dissatisfied patients. Subsequently the reactions were categorized blind by two judges. The 12 possible categories can be subdivided into categories primarily aimed at the contents or primarily aimed at the relationship. The results show that, as compared to the pre-measurements, GPs more frequently use empathic reactions and reactions in which they bring their own actions up for discussion. The number of responses in which doctors ask a further clinical question or in which GPs expect a solution whether from themselves or from others, decrease. It is concluded that the course appears to change for the better the GPs' initial reaction to dissatisfied patients.

Relationship between general practitioners' attitudes and methods of dealing with psychosocial problems.

The relationship between general practitioners' attitudes and the methods they use when dealing with psychosocial problems was investigated using a questionnaire that was answered by a group of 30 general practitioners. The results showed that: (1) the doctor's desire to help is in general associated with the need to be appreciated; (2) when treating sexual problems, the giving of information is associated with a desire to change the patient; (3) when dealing with problems associated with chronic illness, the giving of encouragement to the patient is accompanied by a desire to give advice. The findings suggest that the way in which a general practitioner treats psychosocial problems depends partly on the type of problem and partly on his own attitude.