Level of assertiveness and related outcomes in general practice visits vary between patients

There are notable differences between patients in their level of assertiveness during a visit by the general practitioner (GP). While one patient arrives with a clear request, another merely hints at a suggestion. There is also considerable variation in how often patients express themselves assertively, which seems to make a difference for the visit outcome. These findings are based on research conducted by Nivel. 

Assertive behaviour usually initiated by patients

On average, patients display two assertive behaviours per GP visit, usually on their own initiative. Patients often make a request, for instance by asking for a check-up or medication, express a preference, or introduce a new topic, such as: “And then I had another question, I’ve had heavy legs for a long time.” Less often, it involves making a decision, offering a suggestion, or expressing disagreement with the GP. Some patients do not show any assertive behaviour throughout the entire visit.

An association with the visit outcome

Assertiveness appears to be related to the outcome of the visit. Patients who received a treatment or referral generally displayed more assertive behaviour during the visits studied. Sometimes they explicitly asked for such an outcome, for instance: “I’ve thought about it, and I’ve decided that I do want to have the surgery after all.” Patients who did not behave assertively (12% of the visits) usually received a wait-and-see policy. 

The GP as decisive voice

Nevertheless, in two-thirds of all visits studied, it was still the GP who determined the outcome of the visit. Most often this involved a treatment by the GP or a direct solution to the health issue during the visit. A referral for diagnostics or treatment also occurred regularly, while lifestyle or self-care advice and a wait-and-see policy occurred less frequently. No link was found between assertiveness and the type of complaint or the patient’s sex.

Want to know more?

View all results from the Nivel study in the full publication.

About the study

The study was based on video recordings of routine GP visits conducted in 2022. In total, 19 GPs from 11 practices across the Netherlands participated, conducting visits with 189 patients.