THE ROLE OF THE GENERAL-PRACTITIONERS AFFECTIVE BEHAVIOR IN MEDICAL ENCOUNTERS

In a random sample of 1524 consecutive consultations involving 30 Gene ral Practitioners (GPs), a study was made of the relationship between the GP's affective and instrumental behaviour and patient satisfaction as well as patients' space in the consultation, both at consultation and GP-level. In a subsample of 99 consultations with hypertensive pat ients, an additional study was made of the relationship between the GP 's affective behaviour and the quality of care on three dimensions (te chnical-medical, psychosocial and doctor-patient relationship). The GP 's affective behaviour was negatively correlated with some aspects of his/her instrumental behaviour, in particular with technical-medical i nterventions and prescriptions. On the other hand, the GP's affective behaviour related positively to several measures indicating patients' 'space in the consultation' (consultation length, proportion of patien t talk, patient influence on the diagnosis and the discussion of psych osocial topics). As hypothesized, a positive relation between affectiv e behaviour and all four outcome measures was found. In a series of mu ltivariate analyses affective behaviour proved to be the strongest fac tor in explaining patient satisfaction and quality of care. Dimensions of instrumental behaviour did not explain these outcome measures exce pt for referrals indicating decreasing patient satisfaction; whereas d iscussion of psychosocial topics, consultation length and proportion o f patient talk explained additional variance in some of the outcome me asures. The implications of these findings for general practice as the centre of the professional arena where health problems are encountere d were discussed.