General practitioners referring patients to specialists in tertiary healthcare: a qualitative study
Posted on 2019-12-02 - 04:19
Abstract Background There is a large and unexplained variation in referral rates to specialists by general practitioners, which calls for investigations regarding general practitioners’ perceptions and expectations during the referral process. Our objective was to describe the decision-making process underlying referral of patients to specialists by general practitioners working in a university outpatient primary care center. Methods Two focus groups were conducted among general practitioners (10 residents and 8 chief residents) working in the Center for Primary Care and Public Health (Unisanté) of the University of Lausanne, in Switzerland. Focus group data were analyzed with thematic content analysis. A feedback group of general practitioners validated the results. Results Participating general practitioners distinguished two kinds of situations regarding referral: a) “clear-cut situations”, in which the decision to refer or not seems obvious and b) “complex cases”, in which they hesitate to refer or not. Regarding the “complex cases”, they reported various types of concerns: a) about the treatment, b) about the patient and the doctor-patient relationship and c) about themselves. General practitioners evoked numerous reasons for referring, including non-medical factors such as influencing patients’ emotions, earning specialists’ esteem or sharing responsibility. They also explained that they seek validation by colleagues and postpone referral so as to relieve some of the decision-related distress. Conclusions General practitioners’ referral of patients to specialists cannot be explained in biomedical terms only. It seems necessary to take into account the fact that referral is a sensitive topic for general practitioners, involving emotionally charged interactions and relationships with patients, colleagues, specialists and supervisors. The decision to refer or not is influenced by multiple contextual, personal and clinical factors that dynamically interact and shape the decision-making process.
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Tzartzas, Konstantinos; Oberhauser, Pierre-Nicolas; Marion-Veyron, Régis; Bourquin, Céline; Senn, Nicolas; Stiefel, Friedrich (2019). General practitioners referring patients to specialists in tertiary healthcare: a qualitative study. figshare. Collection. https://doi.org/10.6084/m9.figshare.c.4764974.v1
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AUTHORS (6)
KT
Konstantinos Tzartzas
PO
Pierre-Nicolas Oberhauser
RM
Régis Marion-Veyron
CB
Céline Bourquin
NS
Nicolas Senn
FS
Friedrich Stiefel