GPs ‘deflect blame for rationing’
GPs often cite organisational policies and guidelines when declining patients' requests for treatments, as a means of preserving the doctor-patient relationship, according to qualitative research.
Dr Alex Walter and colleagues from the University of Manchester say their findings offer "insights to managers and policy makers about the complex influences on decision making in consultations".
They suggest that deflecting the "blame" for potential rationing decisions could create more conflict in future if GPs are held responsible for drawing up local guidelines.
The researchers explored GPs' accounts of negotiating refusal of patient requests, and their negotiating strategies, in two separate focus groups (one including eight trainees and the other five fully trained GPs) followed by individual semi-structured interviews.
Analysis of the transcribed discussions and interviews showed that patients' requests for sickness certification, benzodiazepines (typically for insomnia or anxiety) and antibiotics for respiratory infections were the commonest sources of conflict.
Dr Walter and team report in Family Practice that GPs often described employing strategies that deflect blame to third parties, such as the government or primary care organisation. These included explicit reference to guidelines and policies on particular treatments.
The GPs also pointed to local lists of procedures that would not normally be funded, based on vetting by clinicians. When it came to discussing actual costs of treatments, however, while some participants welcomed openness, others were concerned that this would suggest to patients that such expense would not be justified for them.
"The ability of GPs to offset blame for rationing decisions to third parties will be undermined if the same GPs commission services," the authors write. Nevertheless, they add that this may also "strengthen accountability to local GP colleagues".
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By Caroline Price