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Table 1 GP behaviour observed using MAAS-Global and context factors inferred by inductive reasoning1

From: Identifying context factors explaining physician's low performance in communication assessment: an explorative study in general practice

MAAS-items

Observed GP communication behaviour

Inferred context factors

1. Opening

â—‹ opening and establishing contact are very short

â—‹ talks about patient's social and/or family circumstances

â—‹ refers to prior contacts with patient or family

â—‹ gives meaningful (non-)verbal signs of understanding

â—‹ names patients communication pattern

- GP knows patient and his/her social context

- GP knows patients' medical history

- specific patient verbal behaviour (e.g. patient is shy and tacit)

- GP knows patients' way of communicating

- consultation in a series based on protocol (initiative by GP)

2. Follow-up consultation

â—‹ does not name earlier complaints or management

â—‹ does not ask about adherence

â—‹ does not ask about course of complaint

â—‹ goes to physical examination quickly (not asking explorative questions)

â—‹ explicitly states that he follows the protocol

- GP knows patients' medical history

- follow-up consultation in a series (e.g. check up for blood pressure)

- consultation in a series based on protocol (initiative by GP)

- consultation in preventive care (initiative by GP; there are no complaints)

- specific patient verbal behaviour (e.g. patient tells about adherence spontaneously)

3. Request for help

â—‹ does not name request for help

â—‹ does not complete exploring request for help

- GP knows patients' way of communicating

- consultation in preventive care (initiative by GP)

- consultation based on protocol (initiative by GP)

- specific patient verbal behaviour (e.g. patient states wishes and expectations very clearly)

4. Physical Examination (PE)

â—‹ does not explain PE

â—‹ does not give instructions (or only very brief)

â—‹ does not explain or announce what is to be done (in simple PE)

- patient knows PE from prior consultations

- patient has a disease (diagnosis) or (recurrent) problem known to both GP and patient

- characteristics of physical examination

5. Diagnosis

â—‹ does not do any diagnosing

â—‹ does not name findings or diagnosis

â—‹ names patient's health behaviour

â—‹ refers to prior interview/diagnosis

- patient has a disease (diagnosis) or (recurrent) problem known to both GP and patient

- patient is also treated by other provider

- GP knows patient and his/her social context

- GP knows patients' medical history

- diagnosed problem is mainly psychosocial or psychiatric

- specific patient non-verbal behaviour (e.g. patient states diagnosis authoritatively, leaning forward)

- specific patient verbal behaviour (e.g. patient tells extensively about medical history)

6. Management

â—‹ does not share decision on management

â—‹ does not discuss alternatives

â—‹ does not react to cues on psychosocial problems

â—‹ does not discuss feasibility and adherence

â—‹ does not discuss consulting with other provider

â—‹ refers to management by co-provider

â—‹ names patient's health behaviour

â—‹ seems to anticipate on intermediate effects before next encounter

- patient is also treated by other provider

- GP knows patients' medical history

- specific patient non-verbal behaviour (e.g. patient takes control)

- specific patient verbal behaviour (e.g. patient tells about adherence)

- patient has a disease (diagnosis) or (recurrent) problem known to both GP and patient

- the problem urgently needs medical care

- first consultation in a series

7. Consultation closure

â—‹ does not ask general evaluative question

â—‹ does not check perspective for the time being

â—‹ expresses hope that patient will benefit from consultation

- GP knows patient and his/her social context

- specific patient non-verbal behaviour (e.g. patient seems anxious)

8. Exploration

â—‹ does not react to cues on psychosocial problems

â—‹ does not explore within patient's frame of reference

â—‹ does not explore expectations or request for help

- GP knows patients' medical history

- GP knows patients' way of communicating

- GP knows patient and his/her social context

- specific patient non-verbal behaviour (e.g. patient seems impatient and puts pressure on GP)

- specific patient verbal behaviour (e.g. patient presents physical complaints extensively and states wishes and expectations clearly)

- the problem urgently needs medical care

- patient has a disease (diagnosis) or (recurrent) problem known to both GP and patient

- consultation in preventive care (initiative by GP)

- consultation based on protocol (initiative by GP)

9. Emotions

â—‹ does not ask for emotions

â—‹ does not reflect feelings

- GP knows patients' way of communicating

- GP knows patient and his/her social context

- specific patient verbal behaviour

- diagnosed problem is easily solved

10. Providing Information

â—‹ does not discuss consulting with other provider

â—‹ does not announce or categorize information

â—‹ refers to management by co-provider

â—‹ uses authority and experience in providing information

â—‹ invites patient to look into computer together

- GP knows patients' way of communicating

- GP knows patient and his/her social context

- patient is also treated by other provider

- specific patient verbal behaviour (e.g. patient anxiously asks many questions; patient uses medical jargon)

- specific patient non-verbal behaviour (e.g. patient takes control)

11. Summarizing

â—‹ does not summarize

- specific patient verbal behaviour (e.g. patient uses medical jargon)

- specific patient non-verbal behaviour (e.g. patient takes control)

- diagnosed problem is easily solved

12. Structuring

â—‹ sequence is not always logical

â—‹ time spending is not balanced

â—‹ does not/hardly announce phases

â—‹ addresses more persons than patient alone, divides time adequately

â—‹ assesses and structures involvement of other person(s)

- patient is familiar with (physical) examination (PE)

- GP is very experienced

- diagnosed problem is mainly psychosocial

- there is more than one person (patient) present

- specific patient verbal behaviour (patient anxiously asks many questions)

13. Empathy

â—‹ does not express empathy in brief verbal responses

- GP knows patients' way of communicating

- GP knows patient and his/her social context

- specific patient verbal behaviour (patient seems anxious)

- specific patient non-verbal behaviour (e.g. patient takes control)

- diagnosed problem is easily solved

  1. 1 communication behaviour and context factors are only listed; bullets and hyphens at the same height do not have a specific relationship.