Wasting the doctor's time? A video-elicitation interview study with patients in primary care
Social Science and Medicine
Open Access funded by Department of Health UK. Under a Creative Commons license: https://creativecommons.org/licenses/by/4.0/
Reaching a decision about whether and when to visit the doctor can be a difficult process for the patient. An early visit may cause the doctor to wonder why the patient chose to consult when the disease was self-limiting and symptoms would have settled without medical input. A late visit may cause the doctor to express dismay that the patient waited so long before consulting. In the UK primary care context of constrained resources and government calls for cautious healthcare spending, there is all the more pressure on both doctor and patient to meet only when necessary. A tendency on the part of health professionals to judge patients' decisions to consult as appropriate or not is already described. What is less well explored is the patient's experience of such judgment. Drawing on data from 52 video-elicitation interviews conducted in the English primary care setting, the present paper examines how patients seek to legitimise their decision to consult, and their struggles in doing so. The concern over wasting the doctor's time is expressed repeatedly through patients' narratives. Referring to the sociological literature, the history of 'trivia' in defining the role of general practice is discussed, and current public discourses seeking to assist the patient in developing appropriate consulting behaviour are considered and problematised. Whilst the patient is expected to have sufficient insight to inform timely consulting behaviour, it becomes clear that any attempt on the part of doctor or patient to define legitimate help-seeking is in fact elusive. Despite this, a significant moral dimension to what is deemed appropriate consulting by doctors and patients remains. The notion of candidacy is suggested as a suitable framework and way forward for encompassing these struggles to negotiate eligibility for medical time.
We thank Emily Taylor and Antoinette Davey for the patient interviews they undertook, and Natasha Elmore for her assistance with study set-up, participant recruitment and data storage. We are grateful to surgeries, GPs and patients for their participation. Finally we thank the anonymous reviewers for their constructive feedback. The Improve Programme was funded by the National Institute for Health Research's Programme Grant for Applied Research. This paper summarises independent research funded by the National Institute for Health Research (NIHR) under its Programme Grant for Applied Research (Grant Reference Number RP-PG-0608-10050). The views expressed are those of the authors and not necessarily those of the NHS, the NIHR or the Department of Health.
This is the author accepted manuscript. The final version is available from Elsevier via the DOI in this record.
Vol. 176, pp. 113 - 122
Place of publication