Negotiating refusal in primary care consultations: a qualitative study.

Area of Science:

• General Practice
• Healthcare Management
• Qualitative Research

Background:

• Negotiating patient requests is crucial for General Practitioners' (GPs) gatekeeper role.
• Conflicts arise from shared decision-making versus resource allocation, intensified by new commissioning responsibilities.
• GPs face potential stress and patient dissatisfaction when managing these demands.

Purpose of the Study:

• To investigate how GPs handle refusals of patient requests.
• To identify and analyze the negotiation strategies employed by GPs.

Main Methods:

• Qualitative study using two focus groups and 20 semi-structured interviews with GPs and GP registrars.
• Participants sampled by gender, experience, and practice type.
• Thematic content analysis conducted alongside data collection.

Main Results:

• Sickness certification, antibiotics, and benzodiazepines were common problematic requests.
• GP trainees experienced more conflict than experienced GPs.
• Strategies included blaming third parties (e.g., primary care organizations) to maintain the doctor-patient relationship, influenced by patient expectations from prior encounters.

Conclusions:

• The doctor-patient relationship remains central to GP practice.
• GPs' relationships with colleagues and the wider National Health Service (NHS) are significant, especially concerning clinical commissioning.
• The ability of GPs to deflect blame for rationing may be compromised by direct involvement in service commissioning.