Patients 'don't reveal the full story'

Many consultations are unsatisfactory

Poor relationships between doctors and their patients leave many people reluctant to reveal their true fears, say researchers.

They are concerned this could mean that patients are not receiving the right treatment because doctors are failing to get to the bottom of their problems.

It may mean some patients are given prescriptions they are unhappy with, increasing the risk of non-attendance at future consultations.

Unsatisfactory consultation

A mother took her three-year-old daughter to the GP with a cough

She wanted to bring up nine subjects

She only mentioned three, and did say she was against the use of antibiotics

The GP assumed she wanted antibiotics and prescribed an "unnecessary" course

The researchers, whose work is published in the British Medical Journal, analysed GP consultations involving 35 patients at 20 general practices in the south east and West Midlands.

Patients were asked before they went in to see their GP about their fears, thoughts and opinions.

Most patients had five or more items that they wanted to discuss with their doctor.

But only four out of the 35 voiced all their concerns during the consultation.

Of the 33 patients who had symptoms to report, eight did not give all the information and one did not mention his symptoms at all.

Problems arose following 14 of the 35 consultations.

These included patients not taking the medicines prescribed, not reporting side effects or not attending follow-up appointments.

Unsatisfactory consultation

A stressed lorry driver did not want anti-depressants

He was worried about drowsiness, and telling his family

He did not tell his GP and was prescribed sleeping tablets

The patient thought they were anti-depressants, did not take them and missed his next appointment

Lead researcher was Christine Barry, of Brunel University.

She said: "There are some indications that neither doctors nor patients are open to the presentation of fuller agendas, the doctors perhaps lacking confidence to deal with complex agendas and seeing them as overly time-consuming, the patients worried about what is appropriate to communicate and about wasting the doctor's time.

"Yet this partial voicing and facilitating of agendas can produce less effective consultations.

"Both doctors and patients need to change their behaviour to improve outcomes."

Dr Ian Banks, of the Doctor Patient Partnership, said the main problem was that GPs simply did not have enough time to spend with their patients because of pressure of work.

However, he also said that some GPs adopted a macho attitude and refused to accept that they did not have all the answers. This was a particular problem with male patients, who were often very reluctant to talk about their concerns.

Another problem was that patients were often only able to take in a small percentage of the information that they were given by doctors.