Causal attributions of doctor and patients in a diabetes clinic.

This study investigated the level of congruence in causal attributions and diabetes-specific perceived control between doctor and patients during routine diabetes clinic consultations. The effectiveness of a strategy for improving the congruence of doctor and patients' attributions was examined. Fifty-four patients with poorly controlled insulin requiring diabetes mellitus were assigned to one of three forms of consultation: (1) routine consultation, (2) a consultation where doctor and patient explicitly negotiated and agreed the nature of the problem(s) to be discussed, (3) consultation as in (2) but doctor and patient negotiated and agreed not only the problems but also their causal attributions for the problems discussed. Analysis of covariance demonstrated that the experimental manipulations were successful in improving problem and attribution congruence across the groups. Predicted mismatches in perceived control between doctor and patient in Group I were demonstrated, and, as expected, were reduced in Groups II and III. The clinical implications of differing levels of congruence in attributions and perceived control were considered in analyses of glycaemic control and patients' satisfaction with their consultation.