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Objective To examine whether GPs’ communication styles have changed since the introduction and implementation of clinical guidelines for psychosocial problems in Dutch general practice in the 1990s. Methods From a database of 5184 consultations videotaped between 1977 and 2008, 512 consultations assessed by GPs as ‘completely psychosocial’ were coded with RIAS (Roter Interaction Analysis System). The 121 consultations prior to and 391 consultations after implementation of guidelines were analyzed whether communication styles have changed over time. Results We found that GPs were more likely to consider consultations to be mainly (17%) or completely (12%) psychosocial after the implementation of guidelines. They gave more biomedical and psychosocial information and advice in the second period compared to the first period. We also found that empathy decreased over time (frequency of empathic statements by GPs changed from 2.9–3.2 to 1.4–1.6 between periods). Conclusion Communication in psychosocial consultations has changed; GPs have become more focused on task-oriented communication (asking questions, giving information and advice) and less on showing empathy. Practice implications GPs face the challenge of integrating an evidence-based approach of applying guidelines that promote active symptom exploration with understanding patients’ personal contexts and giving room to their emotions.

Aim of the study The aim of this thesis was to investigate changes in doctor-patient communication, within the context of changes over the course of time in general practice care in the Netherlands. We focused on the question: How are changes in general practice (shifts in approaches) reflected in doctor-patient communication (shift in behavior)? We studied a shift from an approach that emphasized comprehensive, personal care toward an approach with a greater focus on evidence-based medicine. Methods To investigate this shift, we observed and compared general practice consultations prior to and after the implementation of various guidelines to study whether GP communication styles display elements of reconciliation between the use of clinical guidelines and the core value of comprehensive and personal care in daily practice. Main findings The findings show that consultations after the implementation of guidelines received higher quality ratings on doctor-patient communication, in particular regarding the quality of biomedical communication. Furthermore, our observational studies indicate that GPs have become more aware of psychosocial aspects that may contribute to physical complaints presented by patients. However, we also found that GPs placed more emphasis on providing biomedical information and advice, rather than on showing compassion during consultations. We also focused on the role of patients and found that patients were not likely to voice their worries openly. Conclusions It is challenging for GPs to find an appropriate balance between providing care in accordance with evidence-based knowledge and guidelines without losing sight of the 'patient-as-person'. In addition, the role of the patient is changing: they are expected to take responsibility for own health. However, patients also experience challenges in finding a balance between taking responsibility and sharing their vulnerability with their GP.

Background Doctor-patient communication has been influenced over time by factors such as the rise of evidence-based medicine and a growing emphasis on patient-centred care. Despite disputes in the literature on the tension between evidence-based medicine and patient-centered medicine, patients’ views on what constitutes high quality of doctor-patient communication are seldom an explicit topic for research. The aim of this study is to examine whether analogue patients (lay people judging videotaped consultations) perceive shifts in the quality of doctor-patient communication over a twenty-year period. Methods Analogue patients (N = 108) assessed 189 videotaped general practice consultations from two periods (1982–1984 and 2000–2001). They provided ratings on three dimensions (scale 1–10) and gave written feedback. With a mixed-methods research design, we examined these assessments quantitatively (in relation to observed communication coded with RIAS) and qualitatively. Results 1) The quantitative analyses showed that biomedical communication and rapport building were positively associated with the quality assessments of videotaped consultations from the first period, but not from the second. Psychosocial communication and personal remarks were related to positive quality assessments of both periods; 2) the qualitative analyses showed that in both periods, participants provided the same balance between positive and negative comments. Listening, giving support, and showing respect were considered equally important in both periods. We identified shifts in the participants’ observations on how GPs explained things to the patient, the division of roles and responsibilities, and the emphasis on problem-focused communication (first period) versus solution-focused communication (last period). Conclusion Analogue patients recognize shifts in the quality of doctor-patient communication from two different periods, including a shift from problem-focused communication to solution-focused communication, and they value an egalitarian doctor-patient relationship. The two research methods were complementary; based on the quantitative analyses we found shifts in communication, which we confirmed and specified in our qualitative analyses.