DISSATISFIED PATIENTS - IMPROVING GENERAL-PRACTITIONERS INITIAL REACTIONS

General practitioners often have difficulty in dealing with dissatisfi ed patients. One underlying reason could be the disturbed relationship between the doctor and the dissatisfied patient. A training course ha s 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 dissat isfied with my treatment?') rather than on a contents level ('How long have you been suffering from this?'). This method seeks to improve th e relationship and the satisfaction of both doctor and patient. Three types of initial reaction to dissatisfied patients were offered to fou r groups of GPs (19 trainees in general practice and 19 trainers in ge neral practice). Pre- and post-measurement were executed by means of r egistering the initial reactions on video-recorded vignettes of re-ena cted dissatisfied patients. Subsequently the reactions were categorize d blind by two judges. The 12 possible categories can be subdivided in to categories primarily aimed at the contents or primarily aimed at th e relationship. The results show that, as compared to the pre-measurem ent, GPs more frequently use empathic reactions and reactions in which they bring their own actions up for discussion. The number of respons es in which doctors ask a further clinical question or in which GPs ex pect a solution whether from themselves or from others, decrease. It i s concluded that the course appears to change for the better the GPs' initial reaction to dissatisfied patients.