Danish GP trainees' experiences of navigating patient expectations for non-indicated procedures or tests: a...

To explore how trainee doctors in general practice navigate patient expectations and requests for non-indicated procedures or tests, and what factors may pressure them into practising defensively.

A qualitative interview study with 13 GP trainees from the Capital Region and Region Zealand in Denmark. An interview guide was developed based on existing literature and a pilot interview with an experienced GP. Data were coded in NVivo (version 15) and analysed using thematic analysis.

The trainees described several challenges when facing patient requests for unnecessary procedures or tests. These challenges were linked to their own uncertainty, patient expectations and behavior, as well as external factors. The trainees described experiencing self-doubt and uncertainty, particularly when their clinical judgement was questioned by patients. Managing patient expectations, especially when patients were worried, sought tangible evidence, or had private health insurance, was described as challenging. Additionally, clinical values and a stressful environment was said to further influence decision-making processes. Together, these factors sometimes pressured the trainees into adopting a more defensive approach. With more experience, many developed greater confidence and argumentation, making it easier to refuse patient requests while maintaining a good relationship.

Our study indicates that uncertainty, patient expectations, and external circumstances may, in certain situations, pressure Danish GP trainees into practising defensively. Managing and navigating both their own and the patient's uncertainty emerges as a key challenge. Future research is needed to explore how trainees can be better supported and educated in managing uncertainty and patient expectations in general practice.