Family Practice ©Oxford University Press 1990
Vol. 7, No. 2 Printed in Great Britain
Disease-Centred Versus PatientCentred Attitudes: Comparison of General Practitioners in Belgium, Britain and The Netherlands Grol R, de Maeseneer J, Whitfield M and Mokkink H. Disease-centred versus patient-centred attitudes: comparison of general practitioners in Belgium, Britain and the Netherlands. Family Practice 1990; 7: 100-103. The attitudes of general practitioners in Belgium, Britain and the Netherlands have been sought to determine if they are patient-centred or disease-centred (that is, doctor-centred). The results indicated that many of the doctors held disease-centred attitudes, which in previous studies in the Netherlands and Belgium had correlated with increased prescribing of symptomatic medication, shorter consultation time, inadequate patient records and poorer standards of care within the consultation. Doctors in Belgium had the highest level of disease-centred attitudes, Dutch doctors the lowest. Possible explanations for these differences include differences in the doctor-patient relationship that exist between these countries. Although the results must be interpreted with some care, they should form a basis for discussions about doctor-patient relations and medical education in each country.
different attitudes to patients and their problems. For example, in Belgium a fee-for-service system is used, whereas in the Netherlands and Britain there is a capitation system. Belgian patients have free access to medical specialists. In Britain and the Netherlands they need a referral from the general practitioner. In Britain vocational training is three years (one year in general practice, two years in hospital), in the Netherlands it was until recently one year in general practice and in Belgium it is possible to start a practice before participating in vocational training activities. The results of attitude comparisons enable us to consider whether we need to modify the health care system or the medical education in each country.
In their daily work general practitioners are confronted by a variety of complaints, problems and diseases. On many occasions it is not immediately clear what the problem is, how the patient perceives his or her symptoms and what kind of help the patient expects from the general practitioner. A considerable proportion of the physical symptoms that are presented refer to non-physical expectations and problems.1 Even with true physical problems, attention has to be paid to patients' ideas, perceptions, expectations and illness behaviour, to ensure that the physician performs adequately and to prevent medicalization of the problem.2 During their medical education most doctors do not learn these important skills. Their education is often more doctor- or disease-centred than patientcentred ,3'4 even though Balint, more than 25 years ago, pointed out the importance of a patient-centred attitude.5 There is even a suggestion of growing cynicism in doctors after graduation.6 In this study we have attempted to measure patient-centred attitudes of general practitioners in three countries. Different cultures, different forms of medical education and different health care systems may lead to
METHOD 'Patient-centredness" is a broad concept. In the opinion of the authors the most relevant aspects of this attitude are:27 —taking the patient and his or her problems, ideas and expectations seriously; —involving the patient in decisions; —giving information to enable the patient to take responsibility for his own health; —feeling responsible for non-medical aspects of the presented problems. These areas were included in a questionnaire that was developed in the Department of General Practice in Nijmegen in the Netherlands. The questions were
Department of General Practice, University of Nijmegen, Postbus 9101, 6500 HB Nijmegen, The Netherlands. 'Department of General Practice, University of Gent, Belgium. "Department of General Practice, University of Bristol, England. Correspondence to Dr Grol.
100
Downloaded from http://fampra.oxfordjournals.org/ at University of Manitoba on June 19, 2015
R GROL, J DE MAESENEER*. M WHITF1ELD" AND H MOKKINK
less patientoriented attitude More prescribing of symptomatic medication Superfluous medical performance Inadequate psychosocial performance Inadequate openness towards patients' ideas and expectations Inadequate information giving */>
Vol. 7, No. 2 Printed in Great Britain
Disease-Centred Versus PatientCentred Attitudes: Comparison of General Practitioners in Belgium, Britain and The Netherlands Grol R, de Maeseneer J, Whitfield M and Mokkink H. Disease-centred versus patient-centred attitudes: comparison of general practitioners in Belgium, Britain and the Netherlands. Family Practice 1990; 7: 100-103. The attitudes of general practitioners in Belgium, Britain and the Netherlands have been sought to determine if they are patient-centred or disease-centred (that is, doctor-centred). The results indicated that many of the doctors held disease-centred attitudes, which in previous studies in the Netherlands and Belgium had correlated with increased prescribing of symptomatic medication, shorter consultation time, inadequate patient records and poorer standards of care within the consultation. Doctors in Belgium had the highest level of disease-centred attitudes, Dutch doctors the lowest. Possible explanations for these differences include differences in the doctor-patient relationship that exist between these countries. Although the results must be interpreted with some care, they should form a basis for discussions about doctor-patient relations and medical education in each country.
different attitudes to patients and their problems. For example, in Belgium a fee-for-service system is used, whereas in the Netherlands and Britain there is a capitation system. Belgian patients have free access to medical specialists. In Britain and the Netherlands they need a referral from the general practitioner. In Britain vocational training is three years (one year in general practice, two years in hospital), in the Netherlands it was until recently one year in general practice and in Belgium it is possible to start a practice before participating in vocational training activities. The results of attitude comparisons enable us to consider whether we need to modify the health care system or the medical education in each country.
In their daily work general practitioners are confronted by a variety of complaints, problems and diseases. On many occasions it is not immediately clear what the problem is, how the patient perceives his or her symptoms and what kind of help the patient expects from the general practitioner. A considerable proportion of the physical symptoms that are presented refer to non-physical expectations and problems.1 Even with true physical problems, attention has to be paid to patients' ideas, perceptions, expectations and illness behaviour, to ensure that the physician performs adequately and to prevent medicalization of the problem.2 During their medical education most doctors do not learn these important skills. Their education is often more doctor- or disease-centred than patientcentred ,3'4 even though Balint, more than 25 years ago, pointed out the importance of a patient-centred attitude.5 There is even a suggestion of growing cynicism in doctors after graduation.6 In this study we have attempted to measure patient-centred attitudes of general practitioners in three countries. Different cultures, different forms of medical education and different health care systems may lead to
METHOD 'Patient-centredness" is a broad concept. In the opinion of the authors the most relevant aspects of this attitude are:27 —taking the patient and his or her problems, ideas and expectations seriously; —involving the patient in decisions; —giving information to enable the patient to take responsibility for his own health; —feeling responsible for non-medical aspects of the presented problems. These areas were included in a questionnaire that was developed in the Department of General Practice in Nijmegen in the Netherlands. The questions were
Department of General Practice, University of Nijmegen, Postbus 9101, 6500 HB Nijmegen, The Netherlands. 'Department of General Practice, University of Gent, Belgium. "Department of General Practice, University of Bristol, England. Correspondence to Dr Grol.
100
Downloaded from http://fampra.oxfordjournals.org/ at University of Manitoba on June 19, 2015
R GROL, J DE MAESENEER*. M WHITF1ELD" AND H MOKKINK
less patientoriented attitude More prescribing of symptomatic medication Superfluous medical performance Inadequate psychosocial performance Inadequate openness towards patients' ideas and expectations Inadequate information giving */>
