Review Dialogues as an Opportunity to Develop a Person-related Overall Diagnosis

Abstract

Background: In the long-term care of patients with chronic conditions, the process aspect of treatment is rarely in the focus of general practitioner(GP)-patient interactions. A specific interaction tool, the Review Dialogue (RD), has been developed to integrate patients’ health-related problems/risks as well as coping strategies/resources and to agree upon shared treatment objectives. Research question: Do periodical RDs contribute to a better achievement of treatment objectives and do they arrive at an overall diagnosis (Balint)? Methods: GPs were randomized either into an intervention group (extra training and regular RD with 20 patients with chronic conditions) or into a control group (usual care). Videos of a sub-sample of patients (5 per practice) were taken at four points in time. This paper focuses on a sub-sample of 125 video-recorded GP-patient interactions, analysed using a semi-standardised procedure (RLI). An in-depth analysis of a maximum variation sample of eight GPs’ videotapes across four points in time was made to identify professional interaction strategies. Results: Implementing the RD and creating an overall holistic diagnosis is case-specific with respect to both, the GPs and the patients. Fostering individualised care RDs might contribute to a better achievement of treatment objectives. Conclusions: Review Dialogues facilitate the GP-patient communication process about diagnostics and therapy helping to make the implied overall diagnosis explicit. Further research is needed.