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Intended for Healthcare Professionals
British Journal of General Practice

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Research Article

Deliberate departures from good general practice: a study of motives among Dutch general practitioners.

M Veldhuis, L Wigersma and I Okkes
British Journal of General Practice 1998; 48 (437): 1833-1836.
M Veldhuis
Department of General Practice, Academic Medical Centre, Amsterdam.
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L Wigersma
Department of General Practice, Academic Medical Centre, Amsterdam.
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I Okkes
Department of General Practice, Academic Medical Centre, Amsterdam.
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Abstract

BACKGROUND: When general practitioners (GPs) act contrary to their own standards of good practice, they usually cite patient demands as the main reason. However, up until now, studies have relied on doctors' recollections of departures from their own norms, which may be unreliable. AIM: To systematically explore GPs' motives for deliberate departures from their own conception of good practice. METHOD: Forty-nine GPs, over five days, registered to what extent they had deviated from their own norms, and recorded the motives underlying any deviation. RESULTS: Of the 6087 consultations registered, 10% contained some departure from 'good' general practice, the majority (75%) of which was perceived by the doctor concerned as 'slight'. Doctors underpinned their departures mostly by referring to the doctor-patient relationship: the wish to be nice was used, on average, in 42% of deviations, and the wish to prevent a conflict in 30%. The most important non-relational motive was clinical uncertainty, which doctors used in 11% of their cases. DISCUSSION: Contrary to common belief, GPs often comply with patient requests because they wish to, and not because they feel forced to. Whether or not this behaviour affects the quality of care is largely dependent on the model of 'good' general practice used.

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British Journal of General Practice: 48 (437)
British Journal of General Practice
Vol. 48, Issue 437
December 1998
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Deliberate departures from good general practice: a study of motives among Dutch general practitioners.
M Veldhuis, L Wigersma, I Okkes
British Journal of General Practice 1998; 48 (437): 1833-1836.

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Deliberate departures from good general practice: a study of motives among Dutch general practitioners.
M Veldhuis, L Wigersma, I Okkes
British Journal of General Practice 1998; 48 (437): 1833-1836.
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