Variation in General Practitioners' Performance towards Patients with Acute Headache

BACKGROUND: There is broad variation in performance in general practice. Little is known about how affective components influence decisions of general practitioners (GPs). OBJECTIVE: To determine whether GPs’ performance is influenced in quantitative, qualitative or economic respects by anxiety shown by a patient presenting with headache. METHODS: Cross sectional study. Male GPs from 53 general practices in urban regions around Duesseldorf, Germany were consulted during normal surgery hours by two different types of female incognito standardised patients (SPs) complaining of identical severe headache with an interval of around three weeks between the visits. One type of SPs presented the symptom in an anxious, the other in a neutral way. SPs covertly audio-recorded the consultations (with doctors’ prior agreement) and completed a standardised checklist. After the second consultation GPs were interviewed about their impression of the patients. MAIN OUTCOME MEASURES: Number of steps towards further investigations (referral rate, X-rays etc.); number of items explored in history taking and procedures performed during physical examinations during the consultations; duration of consultations. RESULTS:The quality of acting and documentation was high. Only 2% of the SPs were uncovered by the GPs. The interindividual variation in doctoring seen in 92 completely documented consultations was broad. Steps towards costly further investigations were taken in 39% of anxious patients, but only in 7% of neutral patients (n=92; Mc Nemar (binomial) probability value 0.00013). The number of items and procedures during the consultation (history taking, physical examination) was similar in both groups of patients with a broad variation. The average consultation length in both groups was about the same (9.8 min; range 1.5-26 min). CONCLUSIONS: The affective components of female patients’ presentation of their headache to male general practitioners show clear quantitative, economic and qualitative effects.