title: How doctors move from generic goals to specific communicative behavior in real practice consultations.
abstract: OBJECTIVE
  To understand how recommendations for communication can be brought into alignment with clinical communication routines, we explored how doctors select communicative actions during consultations.
  
  
  METHODS
  We conducted stimulated recall interviews with 15 GPs (general practitioners), asking them to comment on recordings of two consultations. The data analysis was based on the principles of grounded theory.
  
  
  RESULTS
  A model describing how doctors select communicative actions during consultations was developed. This model illustrates how GPs constantly adapt their selection of communicative actions to their evaluation of the situation. These evaluations culminate in the selection of situation-specific goals. These multiple and often dynamic goals require constant revision and adaptation of communication strategies, leading to constant readjustments of the selection of communicative actions. When selecting consultation goals GPs weigh patients' needs and preferences as well as the medical situation and its consequences.
  
  
  CONCLUSIONS
  GPs' selection of communicative actions during consultations is situational and goal driven.
  
  
  CONCLUSIONS
  To help doctors develop communicative competence tailored to the specific situation of each consultation, holistic communication training courses, which pay attention to the selection of consultation goals and matching communication strategies besides training specific communication skills, seem preferable to current generic communication skills training.
authors.affiliation: School for Public Health and Primary Care (CAPHRI), Maastricht University, Maastricht, The Netherlands. Wemke.Veldhuijzen@maastrichtuniversity.nl
authors.forename: Wemke
authors.initials: W
authors.lastname: Veldhuijzen
authors.forename: Karen
authors.initials: K
authors.lastname: Mogendorff
authors.forename: Paul
authors.initials: P
authors.lastname: Ram
authors.forename: Trudy
authors.initials: T
authors.lastname: van der Weijden
authors.forename: Glyn
authors.initials: G
authors.lastname: Elwyn
authors.forename: Cees
authors.initials: C
authors.lastname: van der Vleuten
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001291:Attitude of Health Personnel; D002648:Child; D002675:Child, Preschool; D002983:Clinical Competence; D003142:Communication; D005194:Family Practice / Q000379:methods / Q000458:organization & administration*; D005260:Female; D006040:Goals; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D008960:Models, Psychological; D008962:Models, Theoretical; D010819:Physician's Role; D010817:Physician-Patient Relations; D010820:Physicians / Q000523:psychology*; D010818:Practice Patterns, Physicians'; D036301:Qualitative Research; D012017:Referral and Consultation; D013997:Time Factors; D055815:Young Adult