What do patients bring up in consultations? An observational study in general practice

Objective. The main aim of the study was to investigate how many and what kind of problems patients present in consultations with their general practitioner (GP). A secondary aim was to explore patients’ views on what is important in consultations. Design. Cross-sectional study including observation of unselected consultations with recording on a pre-designed scheme, and a brief questionnaire filled in by patients. Setting. Four general practices in Oslo, Norway. Subjects. A total of 201 patients in consultations and 177 patients waiting to see their GP. Main outcome measures. Number and characteristics of problems raised by patients, and whether the problems were handled by GPs during the ongoing consultation. Patients’ expectations for the consultation. Results. The mean number of problems raised was 2.6 (range 1–16), and when appointments for acute conditions were excluded, the mean number was 3.3. Somatic problems comprised about half of all problems, and in more than one-quarter of consultations a mental health issue was presented. Female sex and increasing age predicted an increasing number of problems raised. In one-quarter of encounters four or more problems were presented. The vast majority of problems were dealt with by the GPs during the ongoing consultation. “That I am able to address all the problems I have” was rated as highly important by patients. Conclusion. GPs deal with multiple and unrelated problems in daily consultations, which is highly valued by patients. Management of concurrent problems in brief encounters demands training and adequate working conditions, in order to sustain this core value of general practice.