Related Experiment Video

Updated: Oct 11, 2025

E-Patient Counseling Trial E-PACO: Computer Based Education versus Nurse Counseling for Patients to Prepare for Colonoscopy
06:28

E-Patient Counseling Trial E-PACO: Computer Based Education versus Nurse Counseling for Patients to Prepare for Colonoscopy

Published on: August 1, 2019

8.5K

Making complex decisions in uncertain times: experiences of Dutch GPs as gatekeepers regarding hospital referrals

Dieke Westerduin1, Janneke Dujardin1, Jaap Schuurmans1

  • 1Department of Anesthesiology, Pain and Palliative Medicine, Radboud University Medical Center, Nijmegen, The Netherlands.

BMC Medical Ethics
|December 1, 2021
PubMed

Insights

Dutch general practitioners faced ethical dilemmas regarding hospital referrals during the COVID-19 pandemic due to uncertainties and resource limitations. Key dilemmas involved patient autonomy versus paternalism and duty of care versus autonomy and adequate care provision.

Area of Science:

  • General Practice
  • Public Health
  • Medical Ethics

Background:

  • General practitioners (GPs) serve as gatekeepers for hospital access.
  • The COVID-19 pandemic introduced complexities in referral decisions for both COVID-19 and non-COVID-19 patients.
  • GPs navigated increased uncertainties in determining appropriate hospital referrals.

Purpose of the Study:

  • To explore the experiences of Dutch GPs regarding hospital referrals during the COVID-19 pandemic.
  • To identify the ethical dilemmas encountered by GPs in their gatekeeping role.
  • To inform future crisis management guidelines for healthcare referrals.

Main Methods:

  • Semi-structured interviews were conducted with Dutch general practitioners.
  • Participants were recruited using purposive sampling.
  • Thematic analysis with content coding was employed to analyze interview data.

Main Results:

  • Fifteen interviews revealed four key themes.
  • An overarching theme of COVID-19 uncertainties was identified.
  • Ethical dilemmas included patient self-determination vs. GP paternalism, GP duty of care vs. autonomy, and duty of care vs. adequate care provision.

Conclusions:

  • Dilemmas were influenced by COVID-19 knowledge gaps, infection risks, hospital bed scarcity, and patient loneliness.
  • These factors are crucial for developing effective referral guidelines during future health crises.
  • Understanding GP experiences is vital for optimizing healthcare access during pandemics.
Abstract

Keywords:
Ethical issuesGeneral practitionersHospital referralQualitative researchSars coronavirusShared decision making

More Related Videos

Implementation of a Real-Time Psychosis Risk Detection and Alerting System Based on Electronic Health Records using CogStack07:31

Implementation of a Real-Time Psychosis Risk Detection and Alerting System Based on Electronic Health Records using CogStack

Published on: May 15, 2020

7.3K
A Networked Desktop Virtual Reality Setup for Decision Science and Navigation Experiments with Multiple Participants06:28

A Networked Desktop Virtual Reality Setup for Decision Science and Navigation Experiments with Multiple Participants

Published on: August 26, 2018

6.1K

Related Concept Videos

Ethical Dilemmas II01:30

Ethical Dilemmas II

Resolving an ethical dilemma in healthcare involves a systematic approach that considers every aspect of the issue, respecting both the patient's needs and values and the healthcare professional's ethical obligations. Here are potential steps to resolve an ethical dilemma:
1.5K
Obedience01:08

Obedience

According to obedience research, we may harm others under the forceful pressures of an authority figure (Milgram, 1974). How about if the inappropriate orders were delivered with less force? The increasing interdependence between nurses and physicians compelled Hofling and his colleagues to explore nurses’ reactions to a potentially harmful medical request made by the perceived authority figure, the doctor (Hofling, Brotzman, Dalrymple, Graves, & Pierce, 1966). In this situation,...
33.3K
Issues And Trends In Healthcare Delivery System01:29

Issues And Trends In Healthcare Delivery System

The issues and trends in healthcare delivery are constantly changing. The COVID-19 pandemic is one recent issue that wreaked havoc on healthcare systems, causing a shortage of healthcare workers, high demand for medicines and supplies, and increased medical expenditure due to a lack of insurance. Other issues include rising healthcare costs and care fragmentation.
Cost Containment
Payment for healthcare services has historically promoted adoption of costly and often unnecessary or inefficient...
5.9K
The Availability Heuristic01:08

The Availability Heuristic

A heuristic is a general problem-solving framework (Tversky & Kahneman, 1974). You can think of these as mental shortcuts that are used to solve problems. Different types of heuristics are used in different types of situations, and the impulse to use a heuristic occurs when one of five conditions is met (Pratkanis, 1989):
6.6K
Ethical Issues01:27

Ethical Issues

Nurses are essential in patient care, upholding the ethical principles of their profession and effectively navigating ethical dilemmas. Neglecting ethical issues can lead to inadequate patient care, compromised therapeutic relationships, and moral distress among healthcare workers.
Ethical Concerns in Healthcare:
1.3K
Ethical Dilemmas I01:17

Ethical Dilemmas I

Ethical dilemmas in nursing are of utmost importance, as they often arise from the tension between adhering to core ethical principles and the practical realities of healthcare delivery. These dilemmas require nurses to navigate complex situations where competing ethical considerations pull them in different directions.
Let us explore some examples to understand the potentially complex moral decisions nurses face.
Take the case of caring for minors, particularly in areas related to reproductive...
1.2K