The tick and the talk: do patients' survey responses relate to their narrated experience of primary care consultations?

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The problem

Patient experience, measured by questionnaires, has long been an important component of performance measurement in general practice, previously through the Quality and Outcomes Framework, and more recently through the new CQC processes which draw on patients' responses to surveys. This study aimed to understand how patients' responses to a questionnaire relate to their experience of a consultation with a GP.

The approach

Consultations between patients and GPs were video recorded (n=555) with consent from all parties. Immediately following the consultation, patients were asked to complete a questionnaire about the GPs' communication skills, using items adapted from the national GP Patient Survey. A sample of patients subsequently took part in a video elicitation interview (n=52), in which they were shown the video of their consultation as a prompt, and asked to relate their experience to their completion of the questionnaire. Interviews were audio recorded and transcribed verbatim; qualitative analysis followed the principles outlined by Lofland and Lofland1.Participants were between 18 and 95 years of age and presented at the consultation with a wide range of conditions, from minor ailments to advanced disease.


There was a disconnect between the qualitative narrative in the interviews and the quantitative scores on the questionnaire. Whilst participants were able to raise concerns about doctors' behaviours within the interview, they were reluctant to do so in their questionnaire responses. We identified three key factors which impacted on how participants completed the questionnaire about the consultation. These were i) the patients' relationship with the GP, ii) the patients' expectations of the consultation, and iii) perceived power asymmetries between patients and doctors, and a related feeling of dependency on the GP.


Patients are inhibited in providing feedback to GPs through a questionnaire. The factors we identified may, in part, account for observed high scores in patient experience surveys, with patients struggling to transform their experiences into a representative quantitative evaluation of GP performance. Our results suggest that patient surveys, as currently used, are limited tools for enabling patients to feed back their views about consultations, and hence for doctors to improve their practice.Reference:1Lofland, J. and L. Lofland, Analyzing Social Settings. A guide to qualitative observation and analysis. 1995, Belmont: Wadsworth.


  • Jennifer Newbould, University of Cambridge, Cambridge, UK
  • Jenni Burt, University of Exeter, Exeter, UK
  • Antoinette Davey
  • Nadia Llanwarne, University of Exeter, Exeter, UK
  • Natasha Elmore, University of Exeter, Exeter, UK
  • John Campbell
  • Martin Roland, University of Exeter, Exeter, UK