The role of the receptionist in general practice: A ‘dragon behind the desk’?

doi:10.1016/0277-9536(85)90347-8

Social Science & Medicine

Volume 20, Issue 9, 1985, Pages 911-921

https://doi.org/10.1016/0277-9536(85)90347-8 Get rights and content

Abstract

The power and influence of receptionists in general practice has been the subject of little research. We argue that the structural position of receptionists and the nature of primary medical care give receptionists a potential discretionary role in determining access to the general practitioner. A major criterion for access is the imputed urgency of the patient's condition, which frequently involves the receptionist making a medical assessment based on only a brief verbal exchange.

The paper draws on interviews with a sample of over 1000 adults about their experiences of the reception process in general practice. The receptionist's role in the following areas is examined; delay in obtaining appointments, asking the reason for surgery consultations and home visits, reducing the number of home visits by suggesting patients attend the surgery, putting patients through to speak to the doctor on the telephone and giving health advice. Patients who have experienced receptionists as an active intermediary are more likely to report interaction difficulties with receptionists. The survey data lend support to two major findings: (1) that as practices become larger and more complex receptionists operate with more rigid rules, leading to greater hostility expressed by patients towards reception staff; and (2) parents with dependent children and young adults express more antagonism, because they are more likely to experience the receptionist as a ‘gatekeeper’ with whom they need to negotiate to see a doctor for acute care for themselves or for their children.

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Between demarcation and discretion: The medical-administrative boundary as a locus of safety in high-volume organisational routines
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However, recent studies have provided more nuanced perspectives on the relationship between inter-occupational boundaries and patient safety by examining the complex nature of safety and risk in everyday service delivery (Boreham et al., 2000; Grant et al., 2016, 2017; Iedema, 2009; Waring et al., 2016). This work has illustrated the important role of receptionists in upholding safety and quality within the primary care clinical team (Arber and Sawyer, 1985; Swinglehurst and Greenhalgh, 2015), with a recent study by Swinglehurst et al. (2011), for example, examining the ‘hidden creative work’ of front-line receptionist staff in the achievement of prescribing quality and safety in general practice. Two key high-volume routines in UK general practice are repeat prescribing and test results handling.
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This study addresses, for the first time, the effectiveness of receptionists handling incoming calls from patients to access General Practice services.
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We demonstrate how ‘patient burden’ unfolds in two phases of the telephone calls: (i) following an initial rejection of a patient’s request; and (ii) following a receptionist’s initiation of call closing. Our quantitative analysis shows that the three GP services differ in the frequency of ‘patient burden’ and reveals a correlation between the proportion of ‘patient burden’ and independent national satisfaction scores for these surgeries.
Unlike post-hoc surveys, our analysis of live calls identifies the communicative practices which may constitute patient (dis)satisfaction.
Through establishing what receptionists handle well or less well in encounters with patients, we propose ways of improving such encounters through training or other forms of intervention.
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More broadly, while some ethnographic work addressing clinical bias or racism has focused on nurse–patient interactions (see, for example: Jewkes et al., 1998; Spitzer, 2004), only a few ethnographies have specifically analyzed the role and impact of those who do not provide medical care, but do interact with patients. One early exception to this trend consisted of interviews with patients to assess their perceptions of receptionists; findings indicated that patients saw receptionists as controlling boundaries often outside of their scope of work (Arber and Sawyer, 1985). For example, patients described feeling as if they needed to “negotiate” in order to receive care (p. 914).
Ethnographic research on the clinical encounter has focused almost exclusively on what happens in exam rooms—particularly patient-provider interactions—leaving much to be understood about other actors within the clinic. As part of a larger ethnographic study examining the impact of colonialism, transnational migration, discrimination, and gender relations on Chuukese migrant women's reproductive and sexual health outcomes in Guam, I conducted eight months of participant observation in three publicly funded health clinics, 24 interviews with health care workers, and 15 life-history interviews with Chuukese women between September 2012 and February 2014. Findings demonstrated differential treatment of Chuukese patients by front-line workers (FLWs), who engaged in “boundary work” with these patients. Further, care varied by clinic space and the actors in that space. This differential treatment and variation in care impacted Chuukese women's access to and experiences with health care in Guam. Utilizing the concept of “deservingness,” this analysis unpacks how FLWs, like Lipsky's “street-level bureaucrats,” are influenced by bureaucratic, biomedical, and community hierarchies, all contributing to differential patient treatment. This study concludes by calling for more integrated analyses of clinical environments which utilize Lipsky's concept to include community narratives of “deservingness” and incorporate the influence of clinic and community stratification.
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^∗: The authors gratefully acknowledge a grant from the Department of Health and Social Security Small Grants Committee which funded this research. The views expressed in this paper are solely those of the authors and not of the DHSS.

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The role of the receptionist in general practice: A ‘dragon behind the desk’?

Abstract

Soc. Sci. Med.

Bureaucracies

Bureaucracies

The gatekeeper in public housing

The Dynamics of Bureaucracy

Client reception in a Social Service Agency

Publ. Admin.

The Point of Entry: A Study of Client Reception in The Social Services

Receptionist power

New Society

Medical Sociology

Enquiry into administrative activities in general practice

Br. med. J.

The use and perception of a health centre

Practitioner