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Keeping the gate ajar during openings of general practice consultations

Søren Beck Nielsen1

  • 1Department of Scandinavian Studies and Linguistics, University of Copenhagen, Denmark. sbnielsen@hum.ku.dk

Communication & Medicine
|December 26, 2012
PubMed

Insights

Doctors in general practice consultations often delay their decisions when patients request specific services. This strategic deferral of stance allows physicians to gather more information before committing to a

Area of Science:

  • Medical communication
  • General practice
  • Healthcare management

Background:

  • Effective gatekeeping is crucial in general practice to manage healthcare resource utilization.
  • Patient requests for specific services (prescriptions, referrals, sick notes) are common in primary care settings.

Purpose of the Study:

  • To investigate the phenomenon of deferring a stance by general practitioners during the opening of consultations.
  • To analyze this deferral as a potential gatekeeping mechanism in primary care.

Main Methods:

  • Analysis of video recordings of naturally occurring general practice consultations in Denmark.
  • Observational study focusing on doctor-patient interaction dynamics at the start of visits.

Main Results:

  • Doctors were observed to systematically defer their explicit stance when patients initiated requests for clinical services.
  • Physicians employed a questioning strategy, withholding definitive agreement or refusal for extended periods.

Conclusions:

  • Deferring a stance is a significant interactional device used by general practitioners for gatekeeping.
  • This communication strategy allows doctors to manage patient demands and control healthcare resource allocation within primary care.

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