consultation involved agreement with the patient about the nature of the problem, the
action to be taken and subsequent management. Tuckett et al. (1985) likewise argued
that the consultation should be conceptualized as a ‘meeting between experts’ and
emphasized the importance of the patient’s and doctor’s potentially different views of the
problem.
Recent research has examined levels of agreement between GPs’ and patients’ beliefs
about different health problems. Ogden et al. (1999) explored GPs’ and patients’ models
of depression in terms of symptoms (mood and somatic), causes (psychological, medical,
external), and treatments (medical and non-medical). The results showed that GPs and
patients agreed about the importance of mood-related symptoms, psychological causes
and non-medical treatments. However, the GPs reported greater support for somatic
symptoms, medical causes and medical treatments. Therefore, the results indicated that
GPs hold a more medical model of depression than patients. From similar perspective,
Ogden et al. (2001a) explored GPs’ and patients’ beliefs about obesity. The results showed
that the GPs and patients reported similar beliefs for most psychological, behavioural and
social causes of obesity. However, they differed consistently in their beliefs about medical
causes. In particular, the patients rated a gland/hormone problem, slow metabolism and
overall medical causes more highly than did the GPs. For the treatment of obesity, a
similar pattern emerged with the two groups reporting similar beliefs for a range of
methods, but showing different beliefs about who was most helpful. Whereas, the
patients rated the GP as more helpful, the GPs rated the obese patients themselves more
highly. Therefore, although GPs seem to have a more medical model or depression they
have a less medical model of obesity. Research has also shown that doctors and patients
differ in their beliefs about the role of the doctor (Ogden et al. 1997), about the value of
patient centred consultations (Ogden et al. 2002), about the very nature of health
(Ogden et al. 2001b), about chronic disease and the role of stress (Heijmans et al. 2001)
and in terms of what is important to know about medicines (Berry et al. 1997). If the
health professional–patient communication is seen as an interaction, then these studies
suggest that it may well be an interaction between two individuals with very different
perspectives. Do these different perspectives influence patient outcomes?The role of agreement in patient outcomes
If doctors and patients have different beliefs about illness, different beliefs about the role
of the doctor and about medicines, does this lack of agreement relate to patient out-
comes? It is possible that such disagreement may result in poor compliance to medication
(‘why should I take antidepressants if I am not depressed?’), poor compliance to
any recommended changes in behaviour (‘why should I eat less if obesity is caused by
hormones?’) or low satisfaction with the consultation (‘I wanted emotional support and
the GP gave me a prescription’). To date little research has explored these possibilities.
One study did, however, examine the extent to which a patient’s expectations of a
GP consultation were met by the GP and whether this predicted patient satisfaction.
Williams et al. (1995) asked 504 general practice patients to complete a measure of their
expectations of the consultation with their GP prior to it taking place and a measure of
whether their expectations were actually met afterwards. The results showed that having94 HEALTH PSYCHOLOGY