The role of the general practitioner's affective behaviour in medical encounters

In a random sample of 1524 consecutive consultations involving 30 General Practitioners (GPs), a study was made of the relationship between the GP's affective and instrumental behaviour and patient satisfaction as well as patients' space in the consultation, both at consultation and GP-level. In a subsample of 99 consultations with hypertensive patients, an additional study was made of the relationship between the GP's affective behaviour and the quality of care on three dimensions (technical-medical, psychosocial and doctor-patient relationship). The GP's affective behaviour was negatively correlated with some aspects of his/her instrumental behaviour, in particular with technical-medical interventions and prescriptions. On the other hand, the GP's affective behaviour related positively to several measures indicating patients' 'space in the consultation' (consultation length, proportion of patient talk, patient influence on the diagnosis and the discussion of psychosocial topics). As hypothesized, a positive relation between affective behaviour and all four outcome measures was found. In a series of multivariate analyses affective behaviour proved to be the strongest factor in explaining patient satisfaction and quality of care. Dimensions of instrumental behaviour did not explain these outcome measures except for referrals indicating decreasing patient satisfaction; whereas discussion of psychosocial topics, consultation length and proportion of patient talk explained additional variance in some of the outcome measures. The implications of these findings for general practice as the centre of the professional arena where health problems are encountered were discussed.