PREVENTION IN PRACTICE - HOW DO GENERAL-PRACTITIONERS DISCUSS LIFE-STYLE ISSUES WITH THEIR PATIENTS

Forty-six representative consultations in general practice were video recorded. Afterwards the patients and the GPs separately reviewed the recordings and gave their spontaneous comments. A hypothetical-deducti ve analysis, with a starting point in current health educations models , was carried out in order to characterize the health counselling disc ussions. Life-style issues (diet, exercise, smoking and alcohol) were discussed in 15 sequences in eight consultations. Four types of sequen ces were discerned: short advice by the physician (I), a short questio n by the patient (II), lengthy advice by the physician (III) and a pat ient-centred discussion (IV). Most health education constructs studied were identified in the type IV sequence but few in type I-III. In the short and the lengthy advice sequences there was a similar structure; the strategy to affect patients' life-style was condemnations of the patient behaviour and exhortations to change. No physician commented p ositively on these sequences. Appropriate training might improve life- style counselling in general practice through a patient-centred approa ch and with guidance from constructs in health education models.