Importance of patient pressure and perceived pressure and perceived medical need for investigations, referral, and prescribing in primary care: nested observational study

Little, Paul; Dorward, Martina; Warner, Greg; Stephens, Katharine; Senior, Jane; Moore, Michael

doi:10.1136/bmj.38013.644086.7c

Cited by 272 publications

(259 citation statements)

References 18 publications

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“…The literature on MUPS relates requests for diagnostic interventions to 'perceived patient pressure' [25,52]. GPs often miss cues to start discussing psychosocial issues [53,54].…”

Section: Discussionmentioning

confidence: 99%

Worries are the mother of many diseases: General practitioners and refugees in the Netherlands on stress, being ill and prejudice

Feldmann¹,

Bensing

Ruijter

2007

Patient Education and Counseling

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Objective: To confront the views of refugee patients and general practitioners in the Netherlands, focusing on medically unexplained physical symptoms (MUPS). Methods: The study is based on in depth interviews with refugees from Afghanistan (n = 36) and Somalia (n = 30). Additionally, semistructured interviews were conducted with 24 general practitioners. Text fragments concerning the relationship between mental worries and health or physical ailments were subject of a secondary analysis, the results of which are presented. Results: Medically unexplained physical symptoms were a key issue for both refugees and GPs. The GPs saw MUPS as a significant part of the illness presentation by refugee patients. Refugees felt GPs were often prejudiced, too readily using their difficult background as an explanation for physical symptoms. A 'general narrative' circulating in the refugee communities undermines trust. The GPs applied different strategies in dealing with MUPS presented by their refugee patients. A 'human interest strategy' is distinguished from a 'technical strategy'. The results are discussed in the wider context of the literature on MUPS and patient satisfaction. Conclusion: No fundamental difference in paradigms was found between refugees and GPs as to the negative influence worries and bad experiences can have on health. For a fruitful cooperation to develop, based on trust, GPs need to invest in the relationship with individual refugees, and avoid actions based on prejudice. Practice implications: The importance of (a lack of) trust is underestimated in medical practice. Phenomena undermining trust are often out of sight for practitioners. Critical reflection is needed on the strategies practitioners employ to deal with MUPS. #

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“…The literature on MUPS relates requests for diagnostic interventions to 'perceived patient pressure' [25,52]. GPs often miss cues to start discussing psychosocial issues [53,54].…”

Section: Discussionmentioning

confidence: 99%

Worries are the mother of many diseases: General practitioners and refugees in the Netherlands on stress, being ill and prejudice

Feldmann¹,

Bensing

Ruijter

2007

Patient Education and Counseling

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“…The 117 consultations had a median length as reported by doctors of 10 min (interquartile range [5][6][7][8][9][10][11][12][13][14][15]. Patient questionnaires were returned in a median time of 7 days following the consultation (interquartile range 5-12).…”

Section: Resultsmentioning

confidence: 99%

“…[8][9][10][11] In the same way, doctors who perceive greater pressure from patients to make a referral are more likely to refer. 11,12 In one study where a patient presented with fatigue but with no neurological symptoms and asked for a neurology referral, 53% of doctors agreed to the patient's request. 13 Many studies use a post-consultation questionnaire completed either by the doctor or the patient to determine what actions the doctor took during the consultation and thus whether the patient's expectations were met.…”

Section: Introductionmentioning

confidence: 92%

Unmet expectations in primary care and the agreement between doctor and patient: a questionnaire study

Hooper

Rona

French

et al. 2005

Health Expectations

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“…16 Furthermore, the literature shows that patients' expectations often correlate poorly with physicians' perceptions of these expectations. [17][18][19][20][21][22][23][24][25][26][27][28] The aim of the present study was to explore different aspects during the encounter with patients and to separate ideas and concerns and expectations. Research questions were twofold:…”

Section: Introductionmentioning

confidence: 99%

Patients' ideas, concerns, and expectations (ICE) in general practice: impact on prescribing

Matthys¹,

Elwyn²,

Nuland³

et al. 2009

Br J Gen Pract

108

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BackgroundAlthough studies are available on patients' ideas, concerns, and expectations in primary care, there is a scarcity of studies that explore the triad of ideas, concerns, and expectations (ICE) in general practice consultations and the impact on medication prescribing. AimTo evaluate the presence of ICE and its relation to medication prescription. Design of studyCross-sectional study. SettingThirty-six GP teaching practices affiliated with the University of Ghent, in Flanders, Belgium. MethodParticipants were all patients consulting on 30 May 2005, and their doctors. Reasons for an encounter (consultation or home visit) with new and follow-up contacts, the identification of ICE, and the prescription of medication were recorded by 36 trainee GPs undergoing observational training. The study included 613 consultations. ResultsOne, two, or three of the ICE components were expressed in 38.5%, 24.4%, and 20.1% (n = 236, 150, 123) of contacts respectively. On the other hand, in 17.0% (104/613) of all contacts, and in 22% (77/350) of the new contact reasons, no ICE was voiced, and the GPs operated without knowing this information about the patients. Mean number of ICE components per doctor and per contact was 1.54 (standard deviation = 0.54). A logistic regression analysis of the 350 new contacts showed that the presence of concerns (P = 0.037, odds ratio [OR] 1.73, 95% confidence interval [CI] = 1.03 to 2.9), and expectations (P = 0.009, OR = 2.0, 95% CI = 1.2 to 3.4) was associated with not prescribing new medication (dichotomised into the categories present/absent); however, other patient, doctor, and student variables were not significantly associated with medication prescription. ConclusionAn association was found between the presence of concerns and/or expectations, and less medication prescribing. The data suggest that exploring ICE components may lead to fewer new medication prescriptions.

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Importance of patient pressure and perceived pressure and perceived medical need for investigations, referral, and prescribing in primary care: nested observational study

Abstract: Objective To assess how pressures from patients on doctors in the consultation contribute to referral and investigation.

Cited by 272 publications

References 18 publications

Worries are the mother of many diseases: General practitioners and refugees in the Netherlands on stress, being ill and prejudice

Worries are the mother of many diseases: General practitioners and refugees in the Netherlands on stress, being ill and prejudice

Unmet expectations in primary care and the agreement between doctor and patient: a questionnaire study

Patients' ideas, concerns, and expectations (ICE) in general practice: impact on prescribing

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