Introduction Accepting gifts from pharmaceutical sales representatives (sales reps) or meeting them is correlated with excessive, more expensive and sometimes less rational prescribing. French general practitioners (GPs) tend to hold an unfavorable opinion of the pharmaceutical industry, yet the behavior they adopt with sales reps is generally favorable. Until now, no study has sought to explain the reasons for this discrepancy. This study explores GP experiences to better understand their ambivalent behavior. Method This qualitative descriptive study was based on semi-structured face-to-face interviews with French GPs in the south-east of France. An interpretative phenomenological approach was chosen to explore individual professional practices and to model the phenomenon through in-depth analysis of semi-structured interviews. A general inductive analysis was carried out. Data were analyzed by researchers from different disciplines (psychology, sociology and general practice). Results Ten GPs were interviewed for an average of 50 minutes. The analysis revealed three forces that combine to motivate GPs to keep meeting sales reps despite their unfavorable opinion of these visits: practical reasons such as the need for a substitute for continuing education; social and cultural reasons such as courtesy towards representatives; and psychological mechanisms such as cognitive dissonance and a hidden curriculum. Discussion The GP-representative relationship is complex and involves psychological mechanisms that the medical profession often fails to recognize. GPs use reps as a convenient tool for continuing education, particularly in the setting of a private practice where GPs feel pressed for time. Cognitive dissonance is a well-supported theory in social psychology that explains how a person maintains a behavior while having an unfavorable opinion of it. Since GP meetings with sales reps start during their internship, they could also be considered as part of a hidden curriculum. The strength of this work is to combine medical, social psychological and sociological perspectives with the original interpretative phenomenological approach. When the veil is lifted on individual ambivalence, the questions raised are more social and political than individual.

Background Most French people (71%) would like to die at home, but only one out of four actually do. While the difficulties inherent in the practice of home-based palliative care are well described, few studies highlight the resources currently used by general practitioners (GPs) in real life. We have therefore sought to highlight the resources actually used by GPs providing home-based palliative care. Methods Twenty-one GPs of different ages and practice patterns agreed to participate to this qualitative study based upon semi-structured interviews. They were recruited according to a purposive sampling. Transcripts analysis was based upon General Inductive Analysis. Results The resources highlighted have been classified into two main categories according to whether they were internal or external to the GPs. The internal resources raised included the doctor’s practical experience and continuous medical education, personal history, work time organization and a tacit moral contract related to the referring GP’s position. External resources included resource personnel, regional assistance platforms and health facilities, legislation. Conclusion This study provides a simple list that is easy to share and pragmatic solutions for GPs and policymakers. Home-based palliative care practice can simultaneously be burdensome and yet a fulfilling, meaningful activity, depending on self-efficacy and professional exhaustion (burnout), perhaps to a greater extent than on medical knowledge. Home-based palliative care promotion is a matter of social responsibility. The availability of multidisciplinary teams such as regional assistance platforms and Hospitalization at Home is particularly important for the management of palliative care. Policymakers should consolidate these specific resources out of hospitals, in community settings where the patients wish to end their life.

Background: Receiving a gift from pharma reps or meeting them is correlated with an amount of bigger, more expensive and sometimes less rational prescriptions. French General Practitioners (GPs) tend to express an unfavorable opinion towards the pharmaceutical industry; they however adopt rather favorable behavior with pharmaceutical representatives. Yet no study has sought to understand the reasons for this discrepancy. The aim of this study was exploratory: why do some general practitioners receive pharmaceutical representatives when they express an unfavorable opinion regarding the pharmaceutical industry?Method: Qualitative descriptive study by semi-structured face to face interviews with French GPs of the south-east of France. A general inductive analysis was carried out. Data were analysed by researchers from different disciplines (psychology, sociology and general practice).Results: Ten GPs were interviewed for an average time of 50 minutes. The analysis yield to three forces competing to keep meeting pharmaceutical representatives despite unfavorable opinions towards it: practical reasons such as a substitute for continuous training; social and cultural reasons such as propriety toward representatives; psychological mechanisms such as cognitive dissonance and hidden curriculum. Cognitive dissonance is a well-supported social-psychology theory explaining how it is possible to maintain a behavior despite an unfavorable opinion. Since meeting pharma reps is implemented during traineeship, it could be considered as a part of the hidden curriculum. The strengths of this work are the confrontation of medicine, social psychology and sociology with the original approach of the interpretative phenomenological approach.Discussion: The GPs/representative relationship is complex, involving psychological mechanisms which are unknown to the medical profession. GPs use reps as a convenient continuous education tool furthermore in a private practice setting in which GPs feel they lack time. Lifting the veil of individual ambivalence raises questions which are more social and political than individual.