The hidden work of general practitioners: An ethnography

Area of Science:

• Health Services Research
• Primary Care Medicine
• Sociology of Health

Background:

• High-quality primary care is crucial for effective health systems.
• Primary care physicians (general practitioners) globally experience significant workload pressures.
• The non-patient-facing work contributing to these pressures is poorly understood and undervalued.

Purpose of the Study:

• To examine the nature and contribution of non-patient-facing work in primary care.
• To understand how this 'hidden work' impacts physician workload and well-being.
• To propose the term 'hidden care work' to better reflect its nature.

Main Methods:

• Ethnographic observations (104 hours) and in-depth interviews (n=16) were conducted in two English general practices.
• The study involved general practitioners and other primary care staff.
• Analysis was informed by practice theory, the Listening Guide, and empirical ethics.

Main Results:

• 'Hidden work,' including interpreting results, crafting referrals, and managing interruptions, is integral to direct patient care.
• This work is often performed outside of expected hours, leading to inefficiency and increased workload.
• GPs experience a tension between providing comprehensive care and maintaining a manageable workday.

Conclusions:

• The term 'hidden care work' better captures the careful, ambiguous, and uncertain nature of this essential labor.
• Normalizing this work outside of hours exacerbates workload pressures and impacts physician well-being.
• Addressing hidden care work is vital for sustainable primary care and physician retention.