Investigación cualitativa sobre la conceptualización de la hiperfrecuentación por parte del personal médico de atención primaria

Abstract

The frequent attendance is a worrying phenomenon for the health systems of Western countries, due the high work load it generates and its high costs in material and human resources. This work aims to study the meanings, categories and practices that general practitioners build around the frequent attendance. Qualitative study, based on a socio-subjective approximation, through in-depth interviews. Eight interviews were conducted with Primary Health Care physicians in Madrid. The discourses were examined from a pragmatist perspective. The figure of the Primary Health Care physician is at the intersection of professional and institutional contradictory logic, which generates high levels of professional malaise. The social and psychological aspects appear in a confused way, due the consideration of the non-physical aspects as outside the realm of medicine. Frequent attendance is problematic because: it is situated in the center of the sign-symptom dichotomy. its management requires so much time. it requires a comprehensive approach. it avoids the medical performance as a professional who diagnosed and establishes an etiological treatment. These problems eventually can lead to conflict in the professional-patient relationship. The meanings for the frequent attendance will vary significantly depending on the socio-subjective positions, so the approach proposed here could help to understand the complexity of a problem that is built within the relationships between particular subjects crossed by different institutional dynamics, labour disputes, career paths and ideologies.