The challenge of clinical interviewing and physical examination performance for general practitioners in Turkey

Abstract

Background and objectives: This study's objective was to better understand the current conditions and style of practice of generalist physicians in Turkey on clinical interviewing and physical examination skills prior to the widespread availability of family medicine postgraduate training.

Methods: This study was performed in 30 primary health centers, randomly chosen from the 110 primary health centers in Izmir, Turkey. We administered a questionnaire to 106 physicians in those centers, asking about their performance during medical encounters. We then observed 166 first-visit encounters of 37 of those physicians. Finally, we compared physicians' reported behavior (as described in the questionnaires) with their actual performance (when observed).

Results: In the physician questionnaire, 86.8% of participants agreed that 20 minutes or more was sufficient time for first visits, but in practice, 81.9% of the interviews lasted less than 5 minutes. The major reason cited by physicians for short interview times was overcrowding (72.6%). In 94.6% of the encounters, physicians obtained the history of present illness but the rest of the history, such as past history and family history, was gathered in less than 40% of the interviews. Except for the examination of oral cavity and pharynx, lungs, and heart, almost all the rest of the physical examination was performed in less than 10% of the cases. No written records were kept in 63.0 % of the encounters.

Conclusions: The problems and difficulties present in delivering primary care in Turkey include the physicians' behavior in addition to working conditions.