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By Michael Sheldon, John Brooke, Alan Rector

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IN 01' 2110 OOCTORII Work ItO 1'1. Non· wotk tS IJ'/. ,. 17 16 % lwne Spenl VISlTlN0 16 13 12 11 10 9 8 7 I. 3 ? o o Nl A UK DK 15 CAN AI. Figure 7 Percentage of time spent visiting in 11 countries A = Austria AL = Australia B = Belgium CAN = Canada D = West Germany DK = Denmark IS = Israel NL = Holland S = Sweden UK = Uni ted Kingdom US = United States US 'I 24 Decision-making in General Practice But it is in consulting that the difference is most relevant to my theme (Figure 8). British doctors actually spend less time consulting than do other doctors and only about half the time that their Canadian counterparts spend seeing patients in the surgery or office.

7 problems were identified in videotaped interactions. Finally, each interaction takes on a further significance when we realise that the average time the GP will spend with a patient by the time he reached 70 years of age is only 35 hours (Howie, 1985). It is argued that in general practice we should use a patient-centred model as opposed to a doctor-centred model. This means that the doctor sees each patient as a unique individual with a unique illness. Heendeavours to enter and 'tune into' the patient's world and facilitate the expression of his perceptions of his illness.

They see m to be saying the same thing, ie. that what a elinician perceives, how he formulates a problem - the hypotheses he makes - are determined by his mental set, memory structure, world view. The elinicians in their study seem to me to be working at the "doctor-centred" end of the continuum. I could test this by asking them in any of the cases: "What did the elinician say about the patient's fears. What were his expectations in seeking help. How is the problem related to the events in his life?

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