"Every structure we're taught goes out the window": General practitioners' experiences of providing help for patients with emotional concerns'.

Daisy Parker,Rose Mccabe,Chris Dickens,Richard Byng

doi:10.1111/hsc.12860

Abstract

Up to 40% of general practitioners (GP) consultations contain an emotional component. General practitioners (GPs) have to provide care with limited time and resources. This qualitative study aimed to explore how GPs care for patients experiencing emotional concerns within the constraints of busy clinical practice. Seven GPs participated in three focus groups. Groups were recorded, transcribed and analysed thematically. Three themes were identified. (a) Collaboratively negotiated diagnosis: How patients' emotional concerns are understood and managed is the result of a negotiation between patient and GP belief models and the availability of treatments including talking therapy. (b) Doctor as drug: Not only is a continuous relationship between GPs and patients therapeutic in its own right, it is also necessary to effectively diagnose and engage patients in treatment as patients may experience stigma regarding emotional concerns. (c) Personal responsibility and institutional pressure: GPs feel personally responsible for supporting patients through their care journey, however, they face barriers due to lack of time and pressure from guidelines. GPs are forced to prioritise high‐risk patients and experience an emotional toll. In conclusion, guidelines focus on diagnosis and a stepped‐care model, however, this assumes diagnosis is relatively straightforward. GPs and patients have different models of psychological distress. This and the experience of stigma mean that establishing rapport is an important step before the GP and patient negotiate openly and develop a shared understanding of the problem. This takes time and emotional resources to do well. Longer consultations, continuity of care and formal supervision for GPs could enable them to better support patients.

Highlights

Mental health problems are one of the main causes of disease burden worldwide (Vos et al, 2015), and it is estimated that mental health problems cost the UK economy up to £100bn a year (Davis, 2014)
This study aimed to explore general practitioners (GP)’ experiences of providing care for patients experiencing emotional concerns, focusing on the research questions: (a) what are GPs’ experiences of providing care for patients with emotional concerns? (b) what approaches do GPs use that may differ from the guidance?, and (c) how do GPs provide care within the constraints of busy clinical practice?
These three GPs invited between one to two colleagues each from their practice to participate in a focus group

Summary

Introduction

Mental health problems are one of the main causes of disease burden worldwide (Vos et al, 2015), and it is estimated that mental health problems cost the UK economy up to £100bn a year (Davis, 2014). The mental health problems faced in primary care are heterogeneous, undifferentiated and present as a continuum with symptoms of different diagnoses often inextricably linked (Cape, Barker, Buszewicz, & Pistrang, 2000; Gask, Klinkman, Fortes, & Dowrick, 2008). Due to this complexity, this study uses the term ‘emotional concerns’ throughout to reflect the patients most commonly seen by GPs. GPs report feeling responsible for, and engaged in, the identification and management of patients experiencing emotional concerns (Liu, Lu, & Lee, 2008). Difficulties communicating with secondary care services can make GPs feel unable to direct patients to appropriate support (Cohen, 2008)

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