Differences in verbal behaviours of patients with and without emotional distress during primary care consultations

Background. in primary care consultations patients with emotional distress tend to give verbal cues or symptom reports with psychological or psychiatr ic contents. This study examined the cue behaviour defined not only by psyc hological, but also by medical, social and life episodes related contents i n patients with and without emotional distress, recognized and not by their GP. The GP's verbal behaviour in relation to patients' cue emission was al so investigated. Method. For the six participating GPs two groups of matched pairs of patien ts (N = 238) were created. The two groups comprised either patients conside red by GPs as being without emotional distress or patients considered as em otionally distressed. Within each pair, one patient was a case (GHQ-12 scor e > 2) and the other was the matched control (GHQ-12 score < 3). The medica l interviews with these patients were transcribed and classified according to the Verona Medical Interview Classification System (VR-MICS). Results. GHQ positive patients of both groups gave more cues in terms of to tal proportion than their matched controls (GHQ negative patients). The pro portion of cues given by patients was related also to GP's verbal behaviour , increasing with closed psychosocial questions and decreasing with the use of active interview techniques. Attribution of emotional distress was more frequent when patients were high attenders and had a past psychiatric hist ory. The content of cues changed in relation to GP's attribution: recognize d patients gave more cues and more often with psychological content, patien ts not recognized as distressed gave mainly cues related to their lifestyle and life episodes. Conclusions. To improve the recognition of those emotionally distressed pat ients most likely to be missed GPs should increase their attention to cues related to life style and life episodes.