Understanding "revolving door" patients in general practice: a qualitative study

Area of Science:

• General Practice
• Patient Marginalization
• Qualitative Research

Background:

• 'Revolving door' patients are repeatedly removed from general practitioners' (GPs) lists.
• This study explores the experiences of these marginalized patients.
• It forms the qualitative component of a mixed-methods investigation.

Purpose of the Study:

• To characterize 'revolving door' patients from healthcare professionals' perspectives.
• To understand the impact of these patients on general practice services.
• To explore the role of professional schemas in managing challenging patient relationships.

Main Methods:

• Qualitative semi-structured interviews were conducted.
• Participants included six practitioner services staff and six GPs in Scotland.
• Charmazian grounded theory was employed for data analysis.

Main Results:

• 'Revolving door' patients were identified by three key characteristics: unreasonable expectations, inappropriate behaviors, and unmet health needs.
• Boundary breaches were frequently reported during patient-provider interactions.
• Healthcare professionals' perspectives on these patients were systematically explored.

Conclusions:

• The study utilized 'sensitising concepts' of legitimacy, 'good and bad' patients, and 'dirty work designations'.
• Findings relate to the core work of general practice and the influence of medical and moral schemas.
• The research suggests broader implications for understanding problematic doctor-patient relationships.