The aim of this study is to describe a two-step video method, where patients and physicians (on different occasions) comment on the recorded consultations, and to evaluate the method regarding the kind of information received and the influence of the video-camera on patients' and physicians' behaviour. We chose to depart from a phenomenological method introduced by Frankel and Beckman. Their method was modified with regard to the review procedure; the instructions, for example, were changed. Forty-six consultations were videotaped in four primary health care centres. Twelve general practitioners and 46 patients participated. Only a few patients (4) commented without any substantial content or in a completely neutral way. The remaining patients, and all the physicians, gave nuanced descriptions of their experiences during the consultations. Few (1/5) comments dealt with the videotaping itself; e.g. explanations to the research personnel and other irrelevant issues. The influence of the video-camera seemed to be stronger for the physicians than for the patients, but the effects were only marginal. The conclusion is, that by this modified video-method the ability to obtain knowledge to help to understand/interpret the patient-physician relationship was increased. Nowadays video-recording is an established method in behavioural science. In a study about the patient-physician relationship, we plan to use a two-step method of video-recording as the basis for analysing the key factors in the communication. Thus, it is important first to study the possibilities of obtaining valid and reliable information with the method, and then to make a decision about advantages and disadvantages.

No abstract

If general practitioners are to take an active role in the secondary prevention of problems connected with alcohol, they must be able to discuss the subject in an adequate fashion. Interviews from a trial study showed that the greatest difficulties were lack of time and fear of spoiling the relationship with the patient. Earlier studies indicate that the latter problem may have several causes, in part arising from a desire not to infringe upon the integrity of the patient, and partly due to condemnation of excessive drinkers. In other words, the root cause is often contradictory conceptions of alcohol problems on the part of the physician. In order to ensure effective alcohol counselling in primary care, such conceptions must be dealt with in future training courses.

No abstract

For use in system development, a method based on both qualitative and quantitative data was employed to study the difficulties – the dilemmas – a general practitioner (GP) faces during daily consultac tions. Video recordings were used for stimulated recall of the consultation. From 46 consultations, 262 dilemmas were identified by the 12 GPs involved. Medical dilemmas were encountered during three out of four consultations. Dilemmas in the communication with the patient occurred during two consultations out of three, while dilemmas in the organizational environment and dilemmas challenging the GP’s personal competence occurred during one consultation out of three, respectively. A phenomenological analysis of the comments showed that few dilemmas were described as problems during “hypothetico-deductive reasoning”. In many cases the GP found it difficult to understand the situation as a whole. Based on these qualitative data, a model of the GP’s management of ill-structured complex dilemmas is discussed and proposed, to be taken into account in the development of decision support systems for outpatient practice.