[The "doctor" effect in primary care].
OBJECTIVE
To characterize the factors associated with the 'doctor' effect in primary care, as reported in randomized controlled trials (RCTs).


METHODS
A systematic search of Medline (1964-2004) sought to identify all original reports of RCTs, as well as those reported in reviews and metaanalyses. We used the following key words: RCT, doctor-patient relationship, doctor-patient communication, knowledge, skill, attitude, non-pharmacologic effectiveness, primary care.


RESULTS
Ten RCTs and one metaanalysis provided evidence that a combination of emotional and cognitive care has a consistently positive effect on health outcomes. This effect relies on specific attitudes and skills: empathy, reassurance, explanation, counseling, influencing patients' 'health beliefs and expectations, promoting change in behavior, thoughts or emotions. These can be integrated into a specific patient-centered approach to general practice. Medical education must provide training in the relational skills needed for effective treatment.


CONCLUSIONS
Qualitative and quantitative research, including RCTs, are necessary; they should be designed to deal with the heterogenous situations and specific characteristics of general practice.
Moreau
Alain
A
Département de médecine générale, Université Claude Bernard Lyon 1 (69). almoreau@club-internet.fr
Boussageon
Rémy
R
Girier
Pierre
P
Figon
Sophie
S
D006801:Humans; D018802:Patient-Centered Care / Q000592:standards; D010817:Physician-Patient Relations; D010820:Physicians; D011320:Primary Health Care; D000078329:Workforce