Abstract
Reaching a decision about whether and when to visit the doctor can be a difficult process for the patient. An early visit may cause the doctor to wonder why the patient chose to consult when the disease was self-limiting and symptoms would have settled without medical input. A late visit may cause the doctor to express dismay that the patient waited so long before consulting. In the UK primary care context of constrained resources and government calls for cautious healthcare spending, there is all the more pressure on both doctor and patient to meet only when necessary. A tendency on the part of health professionals to judge patients' decisions to consult as appropriate or not is already described. What is less well explored is the patient's experience of such judgment. Drawing on data from 52 video-elicitation interviews conducted in the English primary care setting, the present paper examines how patients seek to legitimise their decision to consult, and their struggles in doing so. The concern over wasting the doctor's time is expressed repeatedly through patients' narratives. Referring to the sociological literature, the history of ‘trivia’ in defining the role of general practice is discussed, and current public discourses seeking to assist the patient in developing appropriate consulting behaviour are considered and problematised. Whilst the patient is expected to have sufficient insight to inform timely consulting behaviour, it becomes clear that any attempt on the part of doctor or patient to define legitimate help-seeking is in fact elusive. Despite this, a significant moral dimension to what is deemed appropriate consulting by doctors and patients remains. The notion of candidacy is suggested as a suitable framework and way forward for encompassing these struggles to negotiate eligibility for medical time.
Highlights
The timing of the first consultation between the primary care doctor and the patient marks the beginning of the patient's journey through the healthcare system, and determines if and when a diagnosis occurs, and whether treatments or referrals ensue (Morgan, 2003)
The general practitioners (GPs) was viewed as the doctor who deals with triage and trivia, whose role was presented in contrast to the hospital doctor for whom the exciting privilege of investigation, diagnosis and treatment was reserved
It was not until the late sixties that the GP enjoyed a renewed identity as the practitioner of biographical medicine, promoted to the status of attending to the person beyond the pathology (Armstrong, 1979). It is within this holistic definition of general practice that minor illness sits more comfortably, in particular if we consider that symptoms deemed barely worthy of medical attention on the surface may be concealing more serious preoccupations or complaints
Summary
The timing of the first consultation between the primary care doctor and the patient marks the beginning of the patient's journey through the healthcare system, and determines if and when a diagnosis occurs, and whether treatments or referrals ensue (Morgan, 2003). If patients present early in the natural course of the disease, symptoms may be vague and mild, and the recommendation offered to the patient is often to watch and wait. In the context of UK primary care, general practitioners (GPs) hold a gatekeeping role to triage and select those few patients who require further investigation and referral, amongst a majority for whom it is appropriate to offer advice, reassurance, watchful waiting or treat in primary care. This gatekeeping role is key to ensuring overall efficiency of the system and avoiding unnecessary medical interventions (Starfield et al, 2005)
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