PROCESS AND OUTCOMES IN GENERAL-PRACTICE CONSULTATIONS - PROBLEMS IN DEFINING HIGH-QUALITY CARE

In order ro explore the relationships between the verbal interactions of the consultation and several outcomes (patient health change, patie nt compliance and the satisfaction of both doctor and patient), 21 Gen eral Practitioners contributed ten audiotaped consultations each, from consecutive consenting adult patients. The effects of GP sex and post graduate training were also investigated, but were found to be minimal . Patient health change was most clearly related to acuteness of sympt oms at presentation, whereas reported compliance was predicted by pati ent satisfaction after the consultation. Different consultations were maximally satisfying for doctors and for patients, and patient and doc tor satisfaction with specific consultations showed little correlation . This result implies that the measurement of quality of care, in gene ral practice at least, is a more complex task than has been assumed, a nd in turn raises issues about whose definition of outcome is relevant in discussing quality of care.