• Else M Zantinge, Peter F M Verhaak, Dinny H de Bakker, Jan J Kerssens, Klaas van der Meer, and Jozien M Bensing.
• NIVEL, Netherlands Institute for Health Services Research, Utrecht, The Netherlands. e.zantinge@nivel.nl
• Patient Educ Couns. 2007 Jul 1; 67 (1-2): 93-9.

ObjectiveTo investigate if general practitioners (GPs) with a higher workload are less inclined to encourage their patients to disclose psychological problems, and are less aware of their patients' psychological problems.MethodsData from 2095 videotaped consultations from a representative selection of 142 Dutch GPs were used. Multilevel regression analyses were performed with the GPs' awareness of the patient's psychological problems and their communication as outcome measures, the GPs' workload as a predictor, and GP and patient characteristics as confounders.ResultsGPs' workload is not related to their awareness of psychological problems and hardly related to their communication, except for the finding that a GP with a subjective experience of a lack of time is less patient-centred. Showing eye contact or empathy and asking questions about psychological or social topics are associated with more awareness of patients' psychological problems.ConclusionPatients' feelings of distress are more important for GPs' communication and their awareness of patients' psychological problems than a long patient list or busy moment of the day. GPs who encourage the patient to disclose their psychological problems are more aware of psychological problems.Practice ImplicationsWe recommend that attention is given to all the communication skills required to discuss psychological problems, both in the consulting room and in GPs' training. Additionally, attention for gender differences and stress management is recommended in GPs' training.

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