Requesting care in a medical encounter: How patients make requests and how general practitioners respond

Objectives: General practitioners (GPs) often deal with patient requests, yet little is known about the types of requests and how GPs respond. We used real-life Dutch consultations (recorded in 2015) to identify how care is requested in clinical practice.

Methods: We analysed sixty-six consultations using an inductively and deductively developed codebook. Coders categorised five items of patient requests: type, speaker, formulation, GP response, and resolution. Correlations between these items were analysed with chi-square analyses.

Results: We identified 257 patient requests. Most requests concerned information or advice (n = 191, 74.3 %). When patients requested medical care, they often did so indirectly (χ² (1)= 69.66, p < .001). Request type predicted the resolution: GPs were more likely to meet requests for information than for medical care (χ²(1) = 5.45, p = .019). More than half of the medical care requests that were followed by an explanation were not met (n = 5, 55.6 %). When a request was not met, GPs used communication strategies such as offering alternatives, referencing examination results, and depersonalisation.

Conclusions: Asking questions, co-construction of a request, and explaining are important diagnostic and therapeutic tools for GPs in conversing with the patient.

Practice implications: These conversational strategies could be trained to help GPs evaluate requests while maintaining a good GP-patient relationship.