Is patient involvement possible when decisions involve scarce resources? A qualitative study of decision-making in primary care
Bibliographic Data
| ID | 4600723 |
|---|---|
| Authors | Ian Rees Jones (0000-0002-1682-9134, St George's Hospital), Lee Berney (St George's Hospital), Moira Kelly (0000-0001-7911-1149, St George's Hospital), Len Doyal (Queen Mary University of London), Chris Griffiths (0000-0001-7935-8694, Queen Mary University of London), Gene Feder (0000-0002-7890-3926), Sheila Hillier (0000-0003-3874-9212, Queen Mary University of London), Guy Rowlands (0000-0001-7388-7771, St George's Hospital), Gillian Rowlands, Sarah Curti (0009-0002-0718-6787, Queen Mary University of London), Sarah Curtis (0000-0002-2569-3304) |
| Year | 2004 |
| Volume | 59 |
| Issue | 1 |
| Pages | 93-102 |
| Publication date | 2004-07-01 |
| Peer Reviewed | Yes |
| Open Access | Yes |
| Type | ARTICLE |
| Venue | Social Science & Medicine (JOURNAL) |
| Journal identifiers | ISSN: 0277-9536 • E-ISSN: 1873-5347 |
| Publisher | Elsevier BV (PUBLISHER) |
| DOI | 10.1016/j.socscimed.2003.10.007 |
| PMID | 15087146 |
| OpenAlex | W2092981579 |
| Language | EN |
| Citations received | 17 |
| References cited | 27 |
Greater patient involvement has become a key goal of health care provision. This study explored the way in which general practitioners (GPs) in the UK manage the dual responsibilities of treating individual patients and making the most equitable use of National Health Service (NHS) resources in the context of the policy of greater patient involvement in decision-making. We undertook a qualitative study incorporating a series of interviews and focus groups with a sample of 24 GPs. We analysed GP accounts of decision-making by relating these to substantive ethical principles and the key procedural principle of explicitness in decision-making. GPs saw patient involvement in positive terms but for some GPs involvement served an instrumental purpose, for instance improving patient 'compliance'. GPs identified strongly with the role of patient advocate but experienced role tensions particularly with respect to wider responsibilities for budgets, populations, and society in general. GPs had an implicit understanding of the key ethical principle of explicitness and of other substantive ethical principles but there was incongruence between these and their interpretation in practice. Limited availability of GP time played an important role in this theory/practice gap. GPs engaged in implicit categorisation of patients, legitimating this process by reference to the diversity and complexity of general practice. If patient involvement in health care decision-making is to be increased, then questions of scarcity of resources, including time, will need to be taken into account. If strategies for greater patient involvement are to be pursued then this will have significant implications for funding primary care, particularly in terms of addressing the demands made on consultation time. Good ethics and good professional practice cost money and must be budgeted for. More explicit decision-making in primary care will need to be accompanied by greater explicitness at the national level about roles and responsibilities. Increased patient involvement has consequences for GP training and ways of addressing rationing dilemmas will need to be an important part of this training. Further research is needed to understand micro-decision-making, in particular the spaces in which processes of implicit categorisation lead to distorted communication between doctor and patient
Business · Context (archaeology · Diversity (politics · Economics · Focus group · Health care · Political science · Public relations · Qualitative research · Scarcity · Sociology · Law · Medicine · Mental Health and Patient Involvement · Nursing · Patient Dignity and Privacy · Patient-Provider Communication in Healthcare · Psychology · Social Psychology · Marketing
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Introduction
| Unique citing works | 17 |
|---|---|
| Citations per year | 0,77 |
| Citation span | 2004 - 2024 (21) |
| Citation velocity | recent |
| Highly cited | No |
| Citation types | Neutral: 17 |