Monologue or dialogue: Role preferences of patients and GPs within the consultation

Abstract

Relatively little is known about the role preferences which patients and doctors have of the medical consultation. The study presented here investigates role schemas of the consultation, and how they vary within patients, within doctors, and between doctors and patients. A questionnaire was designed comprising three attitude scales (Beisecker, 1986; Ewart & Howes, 1991; Haug & Lavin, 1983), the Health Locus of Control, the General Health Questionnaire, whether the patient was consulting with a first or repeat consultation, whether the problem was physical, psychological or both, and measures of sociodemographic variables. The questionnaire was completed by 156 GPs (general practitioners) and 250 patients. Factor analyses on the attitude scales revealed five factors for patients and six factors for doctors. In general, patient role schemas focus on decision outcomes and acknowledge the doctors' expertise and authority. Doctors' schemas are more diverse and there is a willingness to receive patient suggestions concerning diagnosis and treatment. The implications for models of the medical consultation are discussed. Some important within-group differences emerged. However, role preferences of doctors and patients are more often asymmetrical than in direct conflict.