Doctor-patient communication in different European health care systems: Relevance and performance from the patients' perspective

Our aim is to investigate differences between European health care systems in the importance attached by patients to different aspect of doctor-patien t communication and the GPs' performance of these aspects, both being from the patients' perspective. 3658 patients of 190 GPs in six European countri es (Netherlands, Spain, United Kingdom, Belgium, Germany, Switzerland) comp leted pre- and post-visit questionnaires about relevance and performance of doctor-patient communication. Data were analyzed by variance analysis and by multilevel analysis. In the non-gatekeeping countries, patients consider ed both biomedical and psychosocial communication aspects to be more import ant than the patients in the gatekeeping countries. Similarly, in the patie nts' perception, the non-gatekeeping GPs dealt with these aspects more ofte n. Patient characteristics (gender, age, education, psychosocial problems, bad health, depressive feelings, GPs' assessment of psychosocial background ) showed many relationships. Of the GP characteristics, only the GPs' psych osocial diagnosis was associated with patient-reported psychosocial relevan ce and performance. Talking about biomedical issues was more important for the patients than talking about psychosocial issues, unless the patients pr esented psychosocial problems to the GP. Discrepancies between relevance an d performance were apparent, especially with respect to biomedical aspects. The implications for health policy and for general practitioners are discu ssed. (C) 2000 Elsevier Science Ireland Ltd. All rights reserved.