Comparing GP and nurse practitioner consultations

Seale et al¹ have provided a much-needed comparative analysis of the different communication patterns used by GPs and nurse practitioners in their consultations with general practice patients. Their findings, namely that nurse practitioners conduct longer consultations with increased dialogue by both patient and nurse practitioners alike has resonance with previous consultation research regarding variant communication styles among doctors and nurses².

However, while acknowledging that a longer consultation time may have a short-term adverse economic effect, it must also be noted that high levels of patient satisfaction with medical consultations have been consistently associated with higher levels of patient adherence and subsequent quicker recovery from illness or injury, with all of its associated social, psychological and long-term economic benefits.^3,4 In this context, a focus on patient satisfaction in the management of ‘same day’ patients, as exemplified by the observed nurse practitioner consultations, would appear to be a prudent economic choice.

A further point of interest is the nurse practitioners' emphases on ‘social/emotional/patient-centred’ talk in their consultations. This feature of patient-centred talk is an iterative finding of research regarding the nurse practitioner consultation, which has previously been identified both in my own research⁵ and also in the work of Johnson.⁶ In a landmark study of doctor–patient interactions, Mishler⁷ warns of the dangers of neglecting patients' perspectives in consultations, noting that patients accentuate the ‘voice of the lifeworld’, reflecting the subjectivities of everyday life, while in response doctors tend to emphasise the ‘voice of medicine’ as seen in their usage of objective scientific analyses in consultations. Mishler contends that this disparity of focus between doctors and patients in consultations results in ineffective medical care, as patients feel that their concerns are not being met, which has a subsequent detrimental effect on patient satisfaction, which in turn adversely affects patients' compliance with suggested medical treatments. In this sense it would appear that the nurse practitioners in Seale et al's study were responding in an appropriate contextual manner to their patient's concerns even though they were dealing with ‘same day’ presentations.

Finally, with the planned extension to nurse prescribing it can be presumed that nurse practitioner consultation time lengths may shorten as they will no longer be discussing with patients the arrangements for getting prescriptions signed.