A qualitative investigation into why patients change their GPs

Abstract

Patients change doctor after careful consideration and commonly for interpersonal reasons. There is usually one critical factor in the decision to change. Factors may be modifiable or non-modifiable. Critical event audit may enable GPs to analyse the reasons why patients leave their lists.

When Do Older Patients Change Primary Care Physicians?

“…In most cases, the reasons for change were multifactorial. 38 In contrast to this study, a postal survey of British primary care patients who had not changed their address found that the most frequent reasons for changing doctors were distance issues (41%), dissatisfaction with care (35%), and dissatisfaction with practice organization (36%). 39 Safran 40 has identified reasons to be concerned about deterioration in the quality of doctor-patient relationship over the past several years.…”

Do patients want choice? An observational study of neurology consultations

“…Patients whose symptoms were considered 'medically explained' expressed greater satisfaction overall, as well as on the 'rapport' subscale, than those whose symptoms were thought 'medically unexplained'. It has been argued that the 'rapport' subscale of the MISS-21 has particular clinical relevance because studies using other measures have demonstrated that interactions in which physicians are perceived as being empathic, reassuring and as showing positive affect are associated with better patient outcomes [34][35][36][37][38]. This subscale has previously been used in Conversation Analytic (CA) research and been shown to be sensitive to interactional features in primary care consultations [39].…”

Ending the doctor-patient relationship in general practice: a proposed model

“…Similarly, an allegation by the patient that the GP is incompetent or lies to the patient would be seen as a major breach of the rules. Other work, including that by Gandhi et al, 8 has similarly identified that a patient's decision to change GP was often triggered by the GP and/or practice staff being 'rude', the GP not being 'interested' in the patient and by the patient viewing the GP as clinically incompetent. Hayes-Bautista 14 also found that the evaluation by a patient that the practitioner was incompetent led to a patient-initiated termination of the relationship.…”

“…The issue of patient-initiated termination of the doctor-patient relationship has been explored using qualitative interviews with patients who have changed GP without changing address in both the UK 8 and New Zealand, 9 and was also explored by Hayes-Bautista. 14 Hayes-Bautista coined the phrase the 'fade out' to refer to patients who, having decided to terminate the relationship, choose not to return to that particular practitioner.…”

“…7 In particular, the questions of why and how GPs choose to end their relationship with patients have been the subject of very limited empirical study and there is only a small literature on patients' termination of their relationships with doctors. [8][9][10][11] This paper uses theoretical insights obtained from the sociology [12][13][14] and social psychology 15 of social relationships, together with our own empirical work on the removal of patients from GPs' lists, 10,11,16 to develop a model of ending the doctor-patient relationship in general practice.…”