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

A theoretical model was formed, according to grounded theory, to under stand how discussions about psychosocial problems might be designed. I t was used in 19 videotaped consultations where it was considered rele vant 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 ca ses where the patients expressed 'concern', in that the physician enco uraged the patient by using open-ended questions,by flowing up the inf ormation received, and by having an empathic approach. On the other ha nd, in consultations where 'concern' was not expressed, it was noticed that the physician often asked close-ended, leading or negative quest ions, thus putting an end to the dialogue and, as a consequence, to th e 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.