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Family Practice Vol. 7, No. 3, 163-167
© Oxford University Press 1990

research-article

The Association Between Peer Consultations and Three Aspects of Clinical Competence

MM KUYVENHOVEN, HM PIETERS, HM JACOBS, FWMM TOUW-OTTEN and C SPREEUWENBERG

Department of General Practice, University of Utrecht Bijlhouwer straat 6, 3511 ZC Utrecht, The Netherlands

The relationship between the clinical competence of general practitioners and the degree of peer consultation about diagnostic and therapeutic problems was studied. Three aspects of clinical competence are discerned: attention paid to somatic aspects, patient-orientation and risk of unnecessary harm of the management. Clinical competence has been measured by a written simulation of patient-doctor encounters using five patients and assessment procedures in a study with a correlational design. For this study 49 subjects were selected from a population of 184 GPs who completed their vocational training in general practice at the University of Utrecht between 1975 and 1980. They were selected from those who consult their colleagues frequently and systematically about a variety of patients' problems and from those who do so little or not at all. The 49 subjects did not differ from the remainder in several relevant aspects such as practice setting, subscription to medical journals, etc. The 49 GPs are relatively consistent in the quality of attention they pay to somatic aspects. The consistency with regard to the two other aspects is rather low, especially regarding the risk of unnecessary harm. Attention paid to somatic aspects is connected with patient orientation. The latter is also connected with risk of unnecessary harm, but the former is not. The three aspects are more or less separate aspects of clinical competence. Peer consultation has a direct relationship with quality of attention paid to somatic aspects; GPs who do not consult among peers anyway display a lower quality of attention to somatic aspects in comparison to those who do so. In this study the former doctors are all single handed physicians. Practice setting has a direct relationship with risk of unnecessary harm of the management; those working in health centres induce less unnecessary harm than those working in solo and group practices.


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