Table 1 The changing context of discussing psychosocial problems in primary care
Approach | Main focus | Background |
|---|---|---|
Integrative | What is the meaning of the illness for the patient? | In 1959, the Dutch College of General Practitioners stated that general practice care had to be continuous, integrative and personal.1 Under this agreement, GP care was explicitly placed in a broader societal and emotional context and not limited to a biomedical framework. In the years that followed, and more specifically during the 1970s and 1980s, there was greater emphasis on the importance of understanding patients within their personal contexts and GPs were encouraged to let patients talk freely during consultations. Rogers’ client-centered approach2 - in which empathy and unconditional positive regard were keywords - was used as a framework for dealing with psychosocial problems in general practice. |
Evidence-based | How can the illness of the patient be defined? | From the 1990s, more emphasis was placed on evidence-based medicine with the introduction of clinical guidelines in Dutch general practice. These guidelines mostly emphasized active symptom exploration by GPs. In 1994, the Dutch College of General Practitioners published the national clinical guideline for depression.3 Today, there are eight clinical guidelines specifically for psychological problems and the use of guidelines is widely implemented in general practice in the Netherlands.4 |