The doctor-patient relationship is the focus of attention in the medical field. General practice clinic is an important place for providing continuous and comprehensive medical services, and the communication ability of general practitioners (GPs) is particularly important for improving the doctor-patient relationship. However, there are few studies on the current situation of doctor-patient communication in general practice clinic in China.

To understand the characteristics and current situation of doctor-patient conversation in general practice clinic, in order to provide empirical support for improving communication skills of GPs, optimizing doctor-patient communication strategies, and building a harmonious doctor-patient relationship.

Convenience sampling method was used to select eight GPs from one tertiary hospital and three community health service centers (stations). Natural observation method was used to collect 100 doctor-patient conversation corpus from May to August 2024. The Roter Interaction Analysis System (RIAS) was used to classify, code and quantify the doctor-patient conversation, describe the topic structure of the conversation, and analyze the discourse differences.

A total of 18 667 doctor-patient utterances were collected; 8 784 from doctors and 9 883 from patients.The verbal dominance ratio was 0.89, the patient-centeredness score was 1.27, and the psycho-biomedical ratio was 0.10 in the general practice clinic. The three most frequent topics of physician discourse were biomedical information giving (28.78%), active dialogue (25.18%) and biomedical information seeking (13.79%), while the three most frequent topics of patient discourse were biomedical information giving (34.68%), active dialogue (28.45%) and social language (14.82%). GPs were more likely to ask for biomedical information (P=0.001) and psycho-social information (P=0.003) than patients, but less likely to give biomedical information (P<0.05) and psycho-social information (P<0.001) than patients. Patients had more social language than doctors (P=0.003). The verbal dominance ratio, biomedical information seeking, biomedical information giving, biomedical advice and guidance, and step language of GPs in tertiary hospitals were higher than those in community GPs (P<0.05), while the psycho-biomedical ratio, psycho-social advice and guidance, and social language of GPs in tertiary hospitals were lower than those in community GPs (P<0.05). The frequency of biomedical information seeking, biomedical information giving and positive dialogue of GP-patient in the tertiary hospitals were higher than those in the community GP-patient (P<0.05), while the social language of GP-patient in the community was significantly higher than that in the tertiary hospitals (P<0.01) .

The patient occupies a dominant position in the discourse of the doctor-patient conversation in the general practice clinic. The theme of the doctor-patient conversation is mainly biomedical, and the degree of "patient-centered" is relatively good. Compared with patients, general practitioners had more "seeking discourses" and less "giving discourses". Compared with the GPs in the community, the GPs in the tertiary hospitals have a higher proportion of language dominance, more biomedical discourse, and less psycho-social discourse. GPs should pay more attention to patients' emotional needs, information acquisition needs and psycho-social factors of the disease, so as to improve doctor-patient communication skills and medical service quality.

医患关系是医疗领域关注的焦点。全科门诊是提供连续性、综合性医疗服务的重要场所，全科医生的沟通能力对改善医患关系尤为重要，然而目前分析我国全科门诊医患沟通现状的相关研究较少。

了解全科门诊医患会话的特征和现状，以期为提高全科医生沟通能力、优化医患沟通策略、构建和谐医患关系提供实证支持。

采用便利抽样法，选取1家三甲医院和3家社区卫生服务中心（站）的8名全科医生，运用自然观察法，收集其于2024年5—8月的100份医患会话语料，使用医患互动分析系统对医患会话进行分类编码和量化分析，描述全科门诊医患会话主题结构，并分析话语差异。

本研究共收集18 667频次的医患互动话语，其中医生8 784频次，患者9 883频次。全科门诊的医生语言主导比值为0.89，以患者为中心的对话比值为1.27，社会-心理-生物医学对话比值为0.10。医生话语主题频数最多的前3位依次是生物医学信息给予（28.78%）、积极对话（25.18%）和生物医学信息索取（13.79%），而患者话语主题频数最多的前3位依次是生物医学信息给予（34.68%）、积极对话（28.45%）和社交性语言（14.82%）。医生在生物医学信息索取（P=0.001）和社会心理信息索取（P=0.003）上多于患者，而在生物医学信息给予（P<0.05）和社会心理信息给予（P<0.001）上少于患者，患者的社交性语言多于医生（P=0.003）。三甲医院全科医生的语言主导比值、生物医学信息索取、生物医学信息给予、生物医学建议指导、步骤性语言均高于社区全科医生（P<0.05），而社会-心理-生物医学对话比值、社会心理建议指导、社交性语言均低于社区全科医生（P<0.05）；三甲医院全科患者的生物医学信息索取、生物医学信息给予和积极对话均高于社区全科患者（P<0.05），而社区全科患者的社交性语言高于三甲医院全科患者（P<0.01）。

全科门诊医患会话中患者占据话语主导地位，会话主题以生物医学为主，"以患者为中心"程度相对良好；全科医生相较于患者的索取类话语多、给予类话语少；三甲医院全科门诊相较于社区的医生语言主导比值高、生物医学类话语多、社会心理类话语少。提示全科医生应更加关注患者的情感需求、信息获取需求和疾病的社会心理因素，以促进医患沟通能力和医疗服务质量的提升。