title: Changes in general practitioners' sensitivity to patients' distress in low back pain consultations.
abstract: OBJECTIVE
  We aim to study GPs' sensitivity to patients' distress and communication on psychosocial factors prior to and after the introduction of the clinical guideline for low back pain.
  
  
  METHODS
  Consultations from previous studies on doctor-patient communication in the Netherlands were available for secondary analyses. We selected consultations in which patients presented low back pain complaints (N=168; 25 from 1989, 6 from 1995, 116 from 2001, 21 from 2008) and analyzed these consultations using the Roter Interaction Analysis System (RIAS) and the Verona Coding Definitions of Emotional Sequences (VR-CoDES).
  
  
  RESULTS
  GPs more often acknowledged psychosocial factors during consultations after implementation of the guideline for non-specific low back pain. Moreover, patients more often voiced their worries, while GPs put more emphasis on providing biomedical information and counseling during these consultations.
  
  
  CONCLUSIONS
  GPs tend to emphasize biomedical factors rather than supporting their patients emotionally. Patients are likely to voice their worries implicitly, indicating they have a need for emotional support from their GPs.
  
  
  CONCLUSIONS
  GPs now face the challenge of not only recognizing psychosocial aspects during consultations with low back pain, but also actively eliciting concerns regarding these psychosocial aspects.
authors.affiliation: NIVEL, Netherlands Institute for Health Services Research, PO Box 1568, 3500 BN, Utrecht, The Netherlands.
authors.forename: Ligaya
authors.initials: L
authors.lastname: Butalid
authors.affiliation: NIVEL, Netherlands Institute for Health Services Research, PO Box 1568, 3500 BN, Utrecht, The Netherlands; University of Groningen, University Medical Center Groningen, Department of General Practice, Groningen, The Netherlands.
authors.forename: Peter F M
authors.initials: PF
authors.lastname: Verhaak
authors.affiliation: NIVEL, Netherlands Institute for Health Services Research, PO Box 1568, 3500 BN, Utrecht, The Netherlands; Department of Psychology, Faculty of Social and Behavioural Sciences, Utrecht University, The Netherlands.
authors.forename: Jozien M
authors.initials: JM
authors.lastname: Bensing
mesh_terms: D000328:Adult; D001007:Anxiety / Q000523:psychology*; D001291:Attitude of Health Personnel; D003142:Communication; D004645:Empathy; D058006:General Practice / Q000379:methods; D058005:General Practitioners / Q000523:psychology*; D006801:Humans; D017116:Low Back Pain / Q000523:psychology*; D008875:Middle Aged; D009426:Netherlands; D010817:Physician-Patient Relations; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians'; D011320:Primary Health Care; D012017:Referral and Consultation; D014743:Videotape Recording
keywords: Cues and concerns; Doctor–patient communication; General practice; Low back pain; Psychosocial factors