Search

Background: Several western countries have introduced managed competition in their health care system. In the Netherlands, a new health insurance law was introduced in January 2006 making it easier to switch health insurer each year. Objective: The objective was to measure people's intention to switch health insurer and actual switching behaviour. We also examined whether some groups were less inclined to switch health insurer and/or had more difficulty to exert their intention to switch. Design: In October 2006, members of three Dutch panels indicated whether they intended to switch health insurer during that year's open enrolment period. In the beginning of 2007, the same people were asked whether they indeed switched health insurer. Results: Only 1% intended to switch health insurer. Women, older people, lower educated people, people who were insured for a longer period and people who reported a bad or moderate health were less inclined to switch health insurer. The amount of switching was higher among individuals who intended to switch (31%) than among individuals who did not know whether they would switch (7%) and individuals with no intention to switch (2%). Among those who intended to switch health insurer, women and people who reported a good health switched health insurer more often. The years of enrolment were also associated with actual switching behaviour. Discussion and Conclusions: We might have to temper the optimistic expectations on enhanced choice. Future research should determine why people do not switch health insurer when they intend to and which barriers they experience. (aut. ref.)

Goede communicatievaardigheden zijn essentieel voor het goed uitoefenen van de taken door bedrijfsartsen en verzekeringsartsen. In dit artikel wordt onderzocht hoe mensen met een (lichamelijke) chronische ziekte of handicap (15–65 jaar) oordelen over de communicatie met de bedrijfsartsen en verzekeringsartsen. In mei 2007 zijn gestructureerde telefonische interviews gehouden (respons 81%) met leden van het Nationaal Panel Chronisch zieken en Gehandicapten (NPCG) van het NIVEL: 89 over de communicatie met bedrijfsartsen, 81 over verzekeringsartsen. De mensen met een chronische ziekte of handicap die zijn ondervraagd, zijn over het algemeen positief over de communicatie met de bedrijfsarts en met de verzekeringsarts, zij het over de laatstgenoemde iets minder. Zij stellen meer vertrouwen in de bedrijfsarts en zij oordelen positiever over diens bejegening. De verzekeringsarts voldoet in de ogen van de chronisch zieken en gehandicapten minder vaak aan hun verwachtingen over communicatie dan de bedrijfsarts. Hoe hoger het percentage arbeidsongeschiktheid van chronisch zieken en gehandicapten is, des te positiever ze oordelen over de communicatie met de verzekeringsarts.

PurposeThis paper aims to investigate doctor‐patient communication in consultations of newly qualified general practitioners (GPs) in a newly reorganised health care system and differences in consultation characteristics and communication patterns between new European Union (EU)‐countries (Estonia, Poland and Romania) and the old West‐European EU‐countries.Design/methodology/approachObservation of videotaped doctor‐patient consultations by means of Roter's Interactional Analysis System; GP, patient and observer questionnaires. Data were collected from 92 GPs and 1,376 patients in Estonia, Poland and Romania and compared with known data from old EU countries. Main outcome measures were verbal and nonverbal communication of GPs and patients, as well as consultation characteristics.FindingsDifferences were found in the communication patterns of the new EU‐countries Estonia, Poland and Romania compared to the old EU‐countries. For instance, the verbal contribution of the GPs in the new EU‐countries was greater than in the old EU‐countries. Differences were also found between the three new EU‐countries. In Romania there was more psychosocial talk than in the two other new EU‐countries, whereas in Poland and Estonia there was more biomedical talk. The Estonian communication was more affective, the Polish and Romanian more instrumental. In general, the differences were not found to be related to a “new‐old” or “east‐west” distinction. Clearly, cultural norms and values play an important role in doctor‐patient communication.Research limitations/implicationsThe sampling method differed somewhat from one country to another.Practical implicationsWith the integration of Europe in progress, cross‐cultural aspects should be addressed when doctors are being trained in communication skills in their undergraduate and postgraduate education.Originality/valueThis is the first study to investigate doctor‐patient communication in newly reorganised health care systems and differences in doctor‐patient communication between new and old EU‐countries.

Van den Brink-Muinen A, Van Dulmen AM, Jung HP, Bensing JM. Communiceren artsen volgens de verwachtingen van hun patienten? Huisarts Wet 2008;51(3):141-6. Inleiding Dit onderzoek geeft inzicht in de specifieke voorkeuren van patienten voor de communicatie met huisartsen en hoe goed huisartsen daarnaar handelen, volgens patienten zelf en (vooral) op grond van geobserveerd feitelijk gedrag in consulten. Methoden We observeerden video-opnamen van 1787 consulten van 142 huisartsen (gemiddeld 15 per huisarts). De patienten vulden voor het consult op een vragenlijst in wat zij verwachtten van de communicatie. Na het consult rapporteerden zij in welke mate hun huisarts daaraan had voldaan. De voorkeuritems, de feitelijk gedragsitems en het observatieprotocol RIAS meten allemaal zowel affectgerichte als taakgerichte communicatieaspecten. We gebruikten beschrijvende en multiniveau-analyses. Beschouwing De meeste patienten vonden dat de communicatie met hun huisarts tijdens een consult aansloot bij hun voorkeuren. In het algemeen vonden de patienten zowel affect- als taakgerichte communicatieaspecten belangrijk, en kwam de huisarts hier vaak aan tegemoet. Huisartsen blijken goed aan te voelen wat hun patienten belangrijk vinden om over te praten. Vrouwelijke huisartsen waren zowel meer affect- als taakgericht in hun communicatie dan mannelijke huisartsen, speciaal met vrouwelijke patienten. Patienten die vanwege psychosociale klachten naar de huisarts gingen, hadden meer kans op een affectieve dokter dan patienten met een biomedisch probleem. Conclusie We bevelen huisartsen aan om te letten op de voorkeuren van de patienten voor communicatie en om de patienten aan het einde van een consult te vragen of de communicatie naar wens is verlopen.

Goede communicatie is van belang voor de relatie tussen arts en patient. De sekse van huisarts en patient is daarbij een factor om rekening mee te houden. Mannelijke huisartsen praten anders met hun patienten dan vrouwelijke huisartsen, en beiden praten anders met mannelijke dan met vrouwelijke patienten. De toenemende feminisering van het beroep zou de communicatie tussen arts en patient kunnen beinvloeden, en ook tegemoetkomen aan de voorkeur van vooral vrouwelijke patienten voor een vrouwelijke huisarts. Dit artikel beschrijft sekseverschillen in de huisarts-patientcommunicatie, en de mogelijke veranderingen daarin tussen 1987 en 2001. Het beschrijft ook de voorkeuren van patienten voor een vrouwelijke dan wel mannelijke huisarts en in hoeverre aan deze voorkeuren werd voldaan.

Bensing JM, Tromp F, Van Dulmen S, Van den Brink-Muinen A, Verheul W, Schellevis FG. De zakelijke huisarts en de niet-mondige patient: veranderingen in communicatie. Een observatieonderzoek naar consulten met hypertensiepatienten. Huisarts Wet 2008;51(1):6-12. Doel Vaststellen of er in de loop der jaren veranderingen zijn opgetreden in de communicatie tussen huisartsen en hun (hypertensie)patienten. We startten het onderzoek met twee hypothesen: ten eerste verwachtten we dat huisartsen zich in de communicatie met patienten de laatste jaren zakelijker en biomedischer zijn gaan opstellen, als gevolg van het standaardenbeleid en de gegroeide nadruk op efficiency in de gezondheidszorg; ten tweede verwachtten we dat patienten juist mondiger zijn geworden, wat zich zou moeten uiten in meer vragen en een actievere deelname aan het medisch consult. Methoden Wij hebben een secundaire analyse uitgevoerd op bestaand videomateriaal van doorsnee huisartsconsulten uit 1986 en 2002. De twee onderzoeken waarin deze gegevens verzameld werden, gebruikten precies dezelfde methodologie en tussen de groepen patienten bestonden geen sekse- of leeftijdsverschillen van betekenis. Uit de bestaande datasets selecteerden wij de hypertensieconsulten (102 in 1986; 108 in 2002). De communicatie tussen arts en patient codeerden wij met behulp van het Roter Interaction Analysis System (RIAS), op de coderingen pasten wij vervolgens een multilevelanalyse toe. Resultaten Anders dan wij verwachtten, waren de patienten in 2002 juist minder actief dan zestien jaar tevoren: zij praatten minder, namen minder initiatieven, stelden minder vragen en uitten minder zorgen. Artsen stelden in 2002 meer biomedische vragen en gaven meer biomedische informatie, maar toonden minder hun compassie met de patient en zochten minder vaak de dialoog. Over het geheel genomen hadden de consulten in 2002 een meer biomedisch karakter gekregen en waren ze zakelijker geworden dan zestien jaar tevoren. Conclusie De veronderstelling dat huisartsen een gelijkwaardiger relatie hebben gekregen met patienten, die actieve en kritische consumenten zijn geworden, wordt niet gereflecteerd in onze steekproef van hypertensiepatienten. De belangrijkste verandering die wij waarnamen was dat het communicatiepatroon van de huisarts zakelijker en taakgerichter was geworden. De recente nadruk op evidence-based geneeskunde en protocolgestuurde zorg worden hierin gereflecteerd. Ook de introductie van de computer in de huisartsenpraktijk kan hierin een rol spelen. Men kan dus wel wat vraagtekens zetten bij het vermeende vermogen van de moderne geneeskunde om patienten te helpen hun zorgen te uiten.

PURPOSE: Within the time constraints of a typical physician-patient encounter, the full patient agenda will rarely be voiced. Unexpectedly revealed issues that were neither on the patient's list of items for discussion nor anticipated by the physician constitute an emerging agenda. We aimed to quantify the occurrence rate of emerging agendas in primary care practices and to explain the variation between patients and practices. METHODS: This observational cross-sectional study involved 182 primary care practices in 9 European cultural regions. Consecutive primary care consultations were videotaped and rated. Patients completed preconsultation and postconsultation questionnaires assessing their expectations and perceived care. Emerging agenda, determined by using 11-item preconsultation and postconsultation questionnaires, was defined as care perceived by the patient to be in addition to expected care, after adjustment for cultural variations of patient expectations. RESULTS: For consultations involving 2,243 patients (mean age, 44.8 years, 58.4% women), every sixth (15.8%) consultation revealed emerging psychosocial agenda. Biomedical agenda emerged in 14.5% of the consultations. Rates for unmet expectations were 13.6% and 10.3%, respectively, for psychosocial and biomedical problems. Practices showed considerable heterogeneity of occurrence of emerging agenda (biomedical, median 13%, range 0%-67%; psychosocial, median 14%, range 0%-53%). After controlling for region and patient baseline characteristics, variables significantly related to emerging agenda were patient expectations and biomedical or psychosocial discourse content, but not consultation time or sex of the patient. A large proportion of the variance attributable to physicians remained concealed in a practice dummy variable (explaining up to 8% of the variance). CONCLUSION: Unexpected agenda emerges in every sixth to seventh consultation in outpatient primary care visits. peerReviewed

The present study examined the communication sequences consisting of doctors’ responses to patients’ concerns in relation to the patient’s empathic preference and perception and the level of anxiety provoked by the medial visit. More specifically, the following questions were addressed: (1) How many patients prefer an empathic doctor? (2) Do more anxious patients prefer a more empathic doctor? (3) Do doctors respond to patients concerns in an affective or an instrumental way? (4) Are doctors’ adequate responses perceived as such by the patients resulting in lower anxiety levels? (aut.ref.)

This study explores the relation between the diagnosis made by the general practitioner (GP) and his or her communicative behavior within a consultation, by means of the analysis of 2095 videotaped consultations of 168 GPs from six countries participating in the Eurocommunication study. The doctors' diagnoses were coded into ICPC chapters and merged into seven clinically relevant diagnostic clusters. The communicative behavior was gauged by means of the Roter interaction analysis system (RIAS). We found the most important differences for consultations about psychosocial problems as compared to all other diagnostic categories. In these consultations, doctors show more affective behavior, are more concerned about having a good relationship with their patients, ask more questions and give less information than in other consultations. The percentages of utterances in the other diagnostic categories were pretty similar. The communicative behavior of doctors reflects a global pattern in every consultation. This pattern is the most stable for affective behavior (social talk, agreement, rapport building and facilitation). Within instrumental behavior (the other categories), the directions and the information the doctor gives are adapted to the problems presented.

The objectives of this study were to describe the features of consultation within general practice with special attention to the differences between short, moderate and long consultations. An analysis of 2801 videotaped consultations of 183 General Practitioners from six countries participating in the Eurocommunication Study was made. The communicative behaviour was gauged by means of the Roter Interaction Analysis System. The consultation can be seen as a “standard operating procedure” consisting of 8% social behaviour, 15% agreement, 4% rapport building, 10% partnership building, 11% giving directions, 28% giving information, 14% asking questions and 7% counselling. A short consultation can be described as an encounter with a little bit of social behaviour to set the contact, medical questioning, giving directions for the further consultation and advises in order to solve the problem(s) mentioned. In a long consultation doctors take more time for a social talk, they give more attention to the relation or contact with the patient, they listen more extensively, especially to psychosocial problems, and they give more information.

Background: The general practitioner is usually the first health care contact for mental problems. The position of a general practitioner may vary between health care systems, depending on the referral system (gatekeepers versus directly accessible specialists), presence of fixed lists and the payment system. This may influence patients’ expectations and requests for help and GPs’ performance. In this paper the effects of working in different health care systems on demand and supply for psychological help were examined. Methods: Data were collected in six European countries with different health care system characteristics (Belgium, Germany, the Netherlands, Spain, Switzerland and the UK). For 15 consecutive contacts with 190 GPs in the six countries, each patient completed questionnaires concerning reason for visit and expectations (before) and evaluation (after consultation). General practitioners completed registration forms on each consultation, indicating familiarity with the patient and diagnosis. General practitioners completed a general questionnaire about their personal and professional characteristics as well. Results: Practices in different countries differed considerably in the proportion of psychological reasons for the visit by the patient and psychological diagnoses by the GP. Agreement between patients’ self-rated problems and GPs’ diagnoses also varied. Patients in different countries evaluated their GPs’ psychological performance differently as well, but evaluation was not correlated with agreement between request for help and diagosis. In gatekeeping countries, patients had more psycho-social requests, GPs made more psychological diagnoses and agreement between both was relatively high. Evaluation, however, was more positive in non-gatekeeping countries. Individual characteristics of doctors and patients explained only a relatively small part of variance. Conclusions: Health care system characteristics do affect GPs’ performance in psycho-social care.

SUMMARYAims – The aim of this small scale study was to explore interaction sequences during the medical consultation. Specific attention was paid to how doctors responded to patient's concerns and worries. Empathic behaviours ( e.g. concern, partnership, legitimising) and facilitating behaviours (e.g. paraphrasing, agreement) were considered as an adequate response to a patient's concern. Methods – Nine consultations of nine different GPs were randomly selected from a sample of 1600 videotaped doctor-patient consultations, that were all rated with the Roter Interaction Analysis System. Each consultation contained at least 9 utterances of patient's concern. It was investigated how doctors respond within five lags of utterances after a patient's concern. Results – The results showed that doctors more often responded to a patient's concern in a facilitative way than in an empathic way. When an empathic response was given, it appeared mostly during the first utterance after the patient expressed a concern. Conclusions – The findings indicate that sequential analysis is appropriate to investigate a health care provider's specific style of responding. Based on the problems emerged during the sequential analysis, further exploration of the method is recommended.Declaration of Interest: none.

Inleiding Huisarts-patientcommunicatie is van groot belang voor de kwaliteit van zorg. De invloed van nationale kenmerken van gezondheidszorgsystemen, zoals de poortwachtersrol van de huisarts, op de communicatie is tot nu toe niet onderzocht. Daarom is een internationaal vergelijkend onderzoek gedaan naar verschillen in huisarts-patientcommunicatie tussen wel- en niet-poortwachterslanden.

Our aim is to investigate differences between European health care systems in the importance attached by patients to different aspects of doctor-patient communication and the GPs' performance of these aspects, both being from the patients' perspective. 3658 patients of 190 GPs in six European countries (Netherlands, Spain, United Kingdom, Belgium, Germany, Switzerland) completed 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 considered both biomedical and psychosocial communication aspects to be more important than the patients in the gatekeeping countries. Similarly, in the patients' perception, the non-gatekeeping GPs dealt with these aspects more often. 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' psychosocial diagnosis was associated with patient-reported psychosocial relevance and performance. Talking about biomedical issues was more important for the patients than talking about psychosocial issues, unless the patients presented psychosocial problems to the GP. Discrepancies between relevance and performance were apparent, especially with respect to biomedical aspects. The implications for health policy and for general practitioners are discussed.

Differences are investigated between female practice populations of female general practitioners providing women's health care and of women and men general practitioners providing regular health care. Women's health care in the Netherlands is provided in the general practice “Aletta” and is based on the following principles: (1) consideration of the patient's gender identity and gender roles; (2) consideration of the patient's personal and social situation; (3) treating the patient respectfully; (4) encouraging the patient to cope with health problems and stimulating self-responsibility; and (5) avoidance of medicalization. Data were derived from an extensive health interview with 253 women Aletta patients (15 years or older) about socio-demographic characteristics, gender role, attitudes, somatic and mental health status, and medical consumption. The Aletta patients were also asked about their motives in choosing women's health care. Reference groups were comprised of 391 and 628 women patients of women and men general practitioners, respectively, providing regular health care. Logistic regression analyses were performed to explain differences between the three groups. “The Aletta patient” can be characterized as a young, urban, single, highly educated, working, and childless woman, who deliberately chooses women's health care. She is more androgynous than women of other doctors, less inclined to seek help with the GP, she suffers more from psychosomatic and psychosocial problems, and she has poorer mental health. It results in a higher use of mental health care, and also of alternative health care. Women patients of women and men doctors providing regular health care hardly differ between each other in the characteristics described above. Health policy makers should take into consideration that in the future possibly more women will prefer health care in which the ideas of women's health care are being applied. The integration of some important aspects of women's health care into regular health care is recommended.

Several western countries have introduced managed competition in their health care system. In the Netherlands, a new health insurance law was introduced in January 2006 making it easier to switch health insurer each year.The objective was to measure people's intention to switch health insurer and actual switching behaviour. We also examined whether some groups were less inclined to switch health insurer and/or had more difficulty to exert their intention to switch.In October 2006, members of three Dutch panels indicated whether they intended to switch health insurer during that year's open enrollment period. In the beginning of 2007, the same people were asked whether they indeed switched health insurer.Only 1% intended to switch health insurer. Women, older people, lower educated people, people who were insured for a longer period and people who reported a bad or moderate health were less inclined to switch health insurer. The amount of switching was higher among individuals who intended to switch (31%) than among individuals who did not know whether they would switch (7%) and individuals with no intention to switch (2%). Among those who intended to switch health insurer, women and people who reported a good health switched health insurer more often. The years of enrollment were also associated with actual switching behaviour.We might have to temper the optimistic expectations on enhanced choice. Future research should determine why people do not switch health insurer when they intend to and which barriers they experience.

Work-related musculoskeletal disorders (MSDs) are common in general practice. The communication between a general practitioner (GP) and patient is a key element of adequate general practice. No study has investigated the characteristics of communication about work-related matters during consultation of the GP by working patients with MSDs.The aim of this study was to describe the communication about work-related matters between the GP and his patients with paid work who are consulting for MSDs.Descriptive analysis of 680 systematic observations of GP consultations of patients in paid work who were consulting for MSDs.Work was discussed in 227 of 680 consultations in general practice. In 69% of these consultations the patient started communication concerning work-related matters, with an average number of 38.5 (standard deviation 45.7) verbal utterances, equalling, on average, 15% of the total consultation time. In 36% of consultations the patient's working conditions were discussed and in 12% the GP advised on whether to stay at home or return to work. There was a statistically significant positive correlation between the extent to which GPs rated the patient's MSDs to be work related and the number of utterances the GP and patient made about work-related matters during the consultation.Work is not a standard topic of conversation during the GP consultation. GPs could more often start communication about patients' work. A challenge for future GP practice and education is to include discussion of patients' work to optimise patient-centred care.

Objective (1) To describe the importance chronically ill and disabled patients attach to involvement in decision-making when various care types are considered, and (2) to analyse the degree to which these patients are involved in shared decision-making (SDM) regarding these care types, and whether their involvement reflects the importance they attach to SDM. Methods The study sample consisted of 812 chronically ill and disabled patients who experienced a situation of decision-making during the last year. Data were collected by a self-report survey in 2006 and were analysed by multilevel linear regression analyses. Results Participants attached most importance to SDM when occupational healthcare issues were at stake, but perceived their actual involvement in these decisions as relatively low. Patients dealing with decision-making regarding medical care or home care experienced higher levels of involvement. The importance attached to SDM corresponds moderately with the actual role patients experience in the decision-making process. Conclusion The type of care to decide upon impacts on the importance patients attach to SDM as well as on their actual involvement in decision-making. Practice implications We suggest healthcare practitioners to pay attention to the preferred level of patient involvement each time a new care issue has to be decided upon.

Objective This study investigated at a country level how cross-national differences in medical communication can be understood from the first four of Hofstede's cultural dimensions, i.e. power distance, uncertainty avoidance, individualism/collectivism and masculinity/femininity, together with national wealth. Methods A total of 307 general practitioners (GPs) and 5820 patients from Belgium, Estonia, Germany, Great Britain, the Netherlands, Poland, Romania, Spain, Sweden and Switzerland participated in the study. Medical communication was videotaped and assessed using Roter's interaction analysis system (RIAS). Additional context information of physicians (gender, job satisfaction, risk-taking and belief of psychological influence on diseases) and patients (gender, health condition, diagnosis and medical encounter expectations) was gathered by using questionnaires. Results Countries differ considerably form each other in terms of culture dimensions. The larger a nation's power distance, the less room there is for unexpected information exchange and the shorter the consultations are. Roles are clearly described and fixed. The higher the level of uncertainty avoidance, the less attention is given to rapport building, e.g. less eye contact. In ‘masculine’ countries there is less instrumental communication in the medical interaction, which was contrary to expectations. In wealthy countries, more attention is given to psychosocial communication. Conclusion The four culture dimensions, together with countries’ wealth, contribute importantly to the understanding of differences in European countries’ styles of medical communication. Their predictive power reaches much further than explanations along the north/south or east/west division of Europe. Practice implications The understanding of these cross-national differences is a precondition for the prevention of intercultural miscommunication. Improved understanding may occur at microlevel in the medical encounter, as well as on macrolevel in pursuing more effective cooperation and integration of European health care policies.

Background:There is a large variation between different countries regard- ing the presentation of psychological symptoms, their diagnosis and treatment in general practice. A possible explanation for such variation might be the conditions of the health care system in different countries. A gate-keeping function might be facilitating the recog- nition and treatment of mental disorder. Furthermore, the payment system and insurance system are considered of importance. Method: To test these hypotheses, data were collected in 10 European countries with different health care systems. 25 - 43 GPs in each country collected data on 20 consecu- tive doctor-patient contacts, including videotaped consultations, patient and GP question- naires per contact and a general GP questionnaire. Results: There are differences, not related to health care system characteristics, between countries concerning the prevalence of mental distress among patients visiting their GP. Only a minority of distressed patients presented psychological symptoms. Although GPs did not limit their psychological diagnoses to patients presenting with psy- chological symptoms, they also diagnosed only a minority of distressed patients with a psychological diagnosis. In general, psychological presentation and diagnosis in gate- keeping countries and in Switzerland (where GPs were remunerated for psychological diagnosis and treatment) was more frequent than in other countries. Especially in Eastern European countries Estonia, Poland and Rumania the presentation of psychological symp- toms by distressed patients was very uncommon. Psychological treatment was not related to gate-keeping. In case of Switzerland, remuneration seemed an effective incentive. Conclusion: Overall prevalence of mental distress cannot be explained by gate-keeping function of the GP, payment system, remuneration system or differences between Eastern and Western Europe. However, a gate-keeping system appears to lower the threshold for help seeking and diagnosis. Gate-keeping has no clear impact on treatment of mental disor- der in general practice. In this case, remuneration is observed to be effective.

Objective: To get insight into the changes over time of patients' involvement in the decision-making process, and into the factors contributing to patients' involvement and general practitioners' (GPs) communication related to the Medical Treatment Act (MTA) issues: information about treatment, other available treatments and side-effects; informed decision making; asking consent for treatment. Background: Societal developments have changed the doctor-patient relationship recently. Informed decision making has become a central topic. Patients' informed consent was legalized by the MTA (1995). Design: Data of two cross-sectional studies, the First (1987) and Second (2001) Dutch National Survey of General Practice, were compared. Setting and participants: General practice consultations; 16 GPs and 442 patients in 1987; 142 GPs and 2784 patients in 2001. Methods: Consultations were videotaped and rated using Roter's Interaction Analysis System and observer questionnaires; pre- and post-consultation patient questionnaires; and GP questionnaires. Descriptive analyses and multivariate, multilevel analysis were applied. Main results: Most patients reported to have received the information they had considered as important prior to the consultation. There were discrepancies in involvement in treatment decisions and in giving information about other available treatments, side-effects and risks. GPs who were more affective and gave more information, more often involved their patients, especially younger patients, in decision making. In 2001, more informed decision making was observed and the GPs asked consent for a treatment more often, but they less often asked for the patients' understanding. Conclusion: Patients' involvement in decision making has increased over time, but not in every respect. However, this does not apply for all patients, especially the older ones. It should be questioned whether they are willing or capable to be involved and if so, how they could be encouraged.