Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2006 Jun;9(2):130-7.
doi: 10.1111/j.1369-7625.2006.00382.x.

Observing decision-making in the general practice consultation: who makes which decisions?

Sarah Ford  1 , Theo Schofield, Tony Hope
Affiliations

Observing decision-making in the general practice consultation: who makes which decisions?

Sarah Ford et al. Health Expect. 2006 Jun.

Abstract

Objective: To investigate opportunities for, and types of decision making in the general practice (primary care) consultation, and examine differences in skills of those doctors who are successful at meeting their patients' preferences and those who are less successful.

Design: Observation study of doctor-patient consultations in general practice.

Participants: Patients attending for routine appointments in 12 general practice surgeries across Oxfordshire.

Methods: A total of 212 doctor-patient consultations were video-recorded. The patients involved completed a questionnaire to elicit their perceptions of how decisions were made. The video-taped recordings were coded with a new instrument, the Evidence Based Patient Choice Instrument (EBPCI), to classify the number and type of decision-making opportunities arising during each consultation. A total of 149 recordings were coded using the Oxbridge Rating Scale to assess the doctors' consultation styles.

Results: There was a range of decision-making opportunities in addition to those involving medical treatment. With the exception of 'fitness for work', decisions were generally 'doctor led'. There was only moderate agreement between patient perceptions of their level of involvement in decision making and the objective ratings using the EBPCI. There was wide variation in the ability of doctors to meet their patients' preferences for involvement.

Conclusions: There are many decisions made in primary care consultations, in addition to those about medical treatments, in which patients could be involved to a greater extent than they currently are. Some doctors are significantly better than others at meeting different patients' preferences for their decision-making role. Patients' perceptions of shared decision making appears to be influenced by the doctors' general consultation skills.

PubMed Disclaimer

References

    1. Department of Health . The NHS Plan: a Plan for Investment, a Plan for Reform. London: HMSO, 2000.
    1. Coulter A. Partnership with patients: the pros andcons of shared clinical decision‐making. Journal of Health Services Research Policy, 1997; 2: 112–121. - PubMed
    1. Greenfield S, Kaplan S, Ware JE. Expanding patient involvement in care: effects on patient outcomes. Annals of Internal Medicine, 1985; 102: 520–582. - PubMed
    1. Stewart MA. Effective physician patient communication and health outcomes: a review. Canadian Medical Association Journal, 1995; 152: 1423–1433. - PMC - PubMed
    1. Ashcroft R, Hope T, Parker M. Ethical issues and evidence‐based patient choice In: Edwards A, Elwyn G. (eds) Evidence‐Based Patient Choice, Inevitable or Impossible? Oxford: Oxford University Press, 2001: 53–65.

Publication types