Abstract
BackgroundContinuity of care has traditionally been regarded as a core quality of general practice, but the long-term doctor-patient relationship has been put under pressure. In many places practices are expanding, with larger teams and more registered patients, thereby threatening the possibility of patients staying with their own general practitioner (GP). GPs often take it for granted that interpersonal continuity is valuable. However, little is known about how patient satisfaction is related to interpersonal continuity. The purpose of this study is to explore the creation of patient satisfaction or dissatisfaction in the interpersonal relation with the GP, and in a comprehensive way to investigate how this is related to continuity of care.MethodsQualitative study based on 22 interviews with patients from two practices in Denmark. A total of 12 patients saw a regular doctor and 10 saw an unfamiliar doctor. The patients were selected after an observed consultation and sampled purposefully according to reason for encounter, age and sex. Interpretative phenomenological analysis (IPA) was used to study how patients perceive meeting either a regular or an unfamiliar GP. The analysis explored the patients' perception of their interpersonal relationship with their GP, and interpreted the accounts by using social psychological theories.ResultsA long-term continuous relationship with the GP could be satisfactory, but it could also be the reverse. The same pattern was shown in case of an unfamiliar GP. Therefore, patient satisfaction and interpersonal continuity were not causally related. On the contrary, there was a general pattern of how the satisfactory and trustful doctor-patient relationship from the patients' point of view could be created, maintained or destroyed. A pattern where the process of recognition, by respecting and remembering, on the one hand created and maintained satisfaction while humiliation on the other hand destroyed satisfaction in the relationship.ConclusionIt was not valuable to have a continuous relationship unless the GP recognized the patient. The social psychological concept of recognition had two different meanings and the GP had to do both, respect and remember the patient, in order to create and sustain the trustful relationship. The added value of interpersonal continuity had to be combined with recognition.
Highlights
Continuity of care has traditionally been regarded as a core quality of general practice, but the long-term doctor-patient relationship has been put under pressure
The aim of the article is to explore the creation of patient satisfaction or dissatisfaction in the interpersonal relation with the general practitioner (GP) and in a comprehensive way investigate how this is related to continuity of care
In the beginning of the analysis the themes were more descriptive than theoretical, but by linking to social psychological theories [18] it became possible to develop a theoretical pattern for the relationship between interpersonal continuity and patient satisfaction
Summary
Continuity of care has traditionally been regarded as a core quality of general practice, but the long-term doctor-patient relationship has been put under pressure. The purpose of this study is to explore the creation of patient satisfaction or dissatisfaction in the interpersonal relation with the GP, and in a comprehensive way to investigate how this is related to continuity of care. Great efforts have been made to clarify the importance of interpersonal continuity but a theoretical evidence base for interpersonal continuity is lacking It is still not clear how interpersonal continuity makes a difference to the quality of care in general practice. The aim of the article is to explore the creation of patient satisfaction or dissatisfaction in the interpersonal relation with the GP and in a comprehensive way investigate how this is related to continuity of care. We have used the term interpersonal continuity for the relational aspects of this It does not directly address positive or negative aspects of the relationship between the patient and the provider
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