Conditions for gatekeeping when GPs consider patient requests unreasonable: a focus group study

Area of Science:

• General Practice
• Healthcare Management
• Patient-Doctor Relationship

Background:

• Unreasonable patient requests create conflict and challenge general practitioners (GPs) in their gatekeeping role.
• GPs must balance maintaining relationships, preventing medical overuse, and managing resources.
• Knowledge is needed on how GPs can successfully manage these difficult consultations.

Purpose of the Study:

• To explore Norwegian GPs' perceptions of factors enabling effective gatekeeping.
• To understand conditions that promote GP success when facing 'unreasonable' patient requests.

Main Methods:

• Qualitative study using three focus groups with Norwegian GPs.
• Exploration of consultations involving seemingly unreasonable patient requests.
• Thematic cross-case analysis of transcripts using Systematic Text Condensation.

Main Results:

• Three key themes emerged: professional communication skills, a long-term perspective, and acknowledgement/support for the GP's gatekeeping role.
• Effective communication and a focus on long-term patient well-being were vital.
• Support from colleagues and authorities reinforced the GP's gatekeeping function.

Conclusions:

• Prioritizing professional communication and relational continuity is essential for GPs to maintain their gatekeeping role.
• External support for the gatekeeping role from within the profession and society is necessary.