The main objective of the proposed study is to compare doctor-patient communication in different European countries and to investigate how the characteristics of various health care systems affect doctor-patient communication.
The following health care characteristics are considered relevant for doctor-patient communication: mode of access of secondary care (direct or on referral), registration of patients with a GP (fixed list or not), average number of patients per GP, employment status of GPs (independent or employed) and the health insurance system (National health system, co-payment). The selection of countries for participation in this study (Belgium, Germany, the Netherlands, Spain and the United kingdom) is based on differences in these structural features. Doctor-patient communication will be assessed by observing real doctor-patient encounters. Nivel has an experience of more than 15 years with this approach. Twenty-seven to 40 practices per country will participate in the videotaping of consultations with 15 patients per practice. Consultations will be analysed for the content of the conversation, the conversation style, and whether the general practitioners include psychosocial factors when reaching a diagnosis and when proposing a treatment. The expectancies and wishes of the patients will be taken into consideration as well.