General Medical Consultation
Attending a doctor is not an automatic response to a symptom experience. Studies addressing this issue have been performed from different disciplines beyond medicine, including sociology, anthropology and psychology.
Much knowledge has been gained over the last five decades on people’s reasons for seeking medical services. After the Second World War, researchers started moving beyond the presenting symptoms to approach the patients’ view of disease, illness and medical care. The discrepancy between the level of symptom experience and health care utilization was substantiated in studies demonstrating that only minorities of persons, who perceive themselves to be sick, visit their doctor.
Evidence has been compiled on the variation in health care utilization. Ethnicity, class, gender and other aspects of people’s backgrounds including family factors seem to have a strong influence on health care-seeking behaviour. Previous experience with the medical system also seems to be crucial to whether or not people choose to consult their GP.
Thus, the medical care process is the result of a complex interplay between individual factors, which in turn are conditioned by general political, economical and cultural characteristics of the society.
Different models have been suggested to explain health care-seeking behaviour, e.g. the Health Belief Model and the Common Sense Model. Both models are based on psychological theories that have been disputed, due to their lack of important contextual and sociological aspects. These models have been able to explain only some of the reasons for people’s health care-seeking behaviour.
In 1975, the “customer’s approach to ‘patienthood’” was introduced as a useful metaphor to describe a relationship in which the patient has the right to ask for what he wants. The focal point of the customer’s approach is not the presenting complaints or the clinician’s evaluation, but rather the specific services that the patient would like the clinician to provide.
According to the patient-centred clinical method, the voice of the patient is at least as important in the consultation as the traditional medical findings. The doctor’s responsibilities are to obtain a shared understanding of illness and disease by acknowledging patients’ ideas about the nature of the disease, feelings and changes in functional capacity and identifying and pursuing not only the medical agenda but also the patient’s agenda.