Struggling on My Own: A Cognitive Perspective on Frequent Attenders' Conception of Life and Their Interaction with the Healthcare System

Abstract

Different studies reveal that a large percentage of people frequently attending healthcare not only suffer from diffuse somatic symptoms but also from psychological distress and difficulties in dealing with everyday life. Even though they are not always diagnosed with psychiatric disease, questions arise about their mental health. The study aims at describing frequent attenders' conceptions of life, and as a result their health, from a cognitive perspective. A qualitative content analysis of in-depth interviews was carried out with nine service users in primary healthcare. The findings reveal that participants experience themselves as inadequate and as being a burden for others, by whom they experience rejection, in different ways. In order to take part in community with others the person develops compensatory strategies that aim at concealing their inadequacies, thus also preventing them from sharing their suffering with others. The consequence is that the persons become even more alienated as they start to relate to others through a façade and furthermore are unable to either improve their health or obtain adequate care. It can be concluded that these patients need to be taken seriously in order to prevent further psychological suffering.

Experience of being a frequent user of primary care and emergency department services: a qualitative systematic review and thematic synthesis

“…Studies show that between 2% and 10% of the population accounts for 15%-80% of healthcare costs. [1][2][3][4][5][6] Even if past research did not consistently define frequent users, a recurring definition of frequent use of emergency department (ED) is four or more visits in the previous year. 4 7-13 In the recent years, many jurisdictions have attempted to implement different public policies to optimise the use of health services by frequent users.…”

Frequent callers in primary health care – a qualitative study with a nursing perspective

“…Patient and nurse perspectives are investigated in a minority of the studies (Malone , Neal et al . , Wiklund‐Gustin , ). Furthermore, there is no consensus regarding the definition of a frequent attender.…”

“…The few studies conducted from a patient perspective have shown that frequent attenders of primary healthcare services describe a situation where they feel mistrusted and rejected by healthcare providers (Neal et al . , Wiklund‐Gustin , ). There are challenges in relation to the potential overuse and unnecessary use of services for healthcare organizations with finite resources.…”

Frequent attenders in general practice and immigrant status in Norway: A nationwide cross-sectional study

“…Frequent attenders (FAs) defined as the top 10% of general practice attenders, account for up to 50% of all contacts [ 1 , 2 ] in general practice, disproportionately consuming the general practitioner's (GP) and patient's time [ 2 , 3 ] and health resources [ 4 ] but not necessarily receiving optimal health care [ 5 ] and sometimes feeling themselves to be a burden to society [ 6 ]. Despite different definitions and high heterogeneity, FAs are characterized by increasing age, female gender, low social support, living alone, unemployment, and low income [ 1 , 7 ].…”

“…Moreover, high rates of physical and mental disease [ 1 , 7 , 8 ] multimorbidity [ 1 ], higher drug use, and polypharmacy [ 9 ] have been reported among FAs. Being a FA might be adequate if the patient needs frequent medical advice and control or to compensate for communication difficulties, but might be a sign of the patient not obtaining the expected help [ 5 , 6 , 29 ].…”