Experiences Of General Practitioners Research Articles

Abord de l’orientation sexuelle des patientes : représentations et pratiques des médecins généralistes

While more and more women say they are non-heterosexual, they feel that they benefit from poorer follow-up, both quantitative and qualitative, in general medicine than heterosexual women. Few studies focus on the experience of general practitioners with this audience. To identify the medical practionners' representations and pratices in approaching the sexual orientation with female patients. This is a qualitative study with data from 10 interviews with general practitioners selected as part of a theoretical sampling. Grounded theory-based analysis was used. General practioners deduced sexual orientation from one of its 3 components: attraction, practices and sexual identity. General practitioners described heteronormative behaviors but some operated a progressive distancing from it. In practice, this resulted in an inclusive approach of non-heterosexual people with an absence of presumption of heterosexuality. Whether or not to discuss sexual orientation depended on general practioners' perceptions of the usefulness and intrusiveness of this data. Social representations and stereotypes of the sexuality of non-heterosexual female patients could lead to discrimination in access to care. Identifying one's social representations and questioning one's heteronormativity allows for more inclusive care of non-heterosexual female patients. Supporting students and professionals in this process is one of the keys to better support for minority people.

General practice experiences for parents of children with intellectual disability. Systematic review.

Parents of children diagnosed with intellectual disability are at increased risk of mentaland physical health difficulties compared to other parents. They are likely to regularly seek medical treatment for their health concerns from general practice as well as on behalf of their child with intellectual disability, yet there is limited evaluation of the role general practice plays for this patient group. To explore parents' experiences of general practice support when caring for a child with intellectual disability. Systematic review of studies reporting experiences of general practice as described by parents who care for children with intellectual disability METHODS: Databases were searched using a pre-defined search strategy. Studies were included based on detailed inclusion criteria, title, abstract and full-text screening. Quality assessment was conducted using the Mixed Methods Appraisal Tool (MMAT). A narrative synthesis was conducted. A total of nine studies were identified. There was a clear absence of data on parents own health experience and consultation in general practice. Findings relate to navigating general practice on behalf of their child's health including accessibility of general practice and positive and negative experiences of general practitioners (GP). Findings from this review highlight priority areas for research and the importance of continuity of care for this patient group. This review also considers implications for clinical services.

Qualitative systematic review of general practitioners’ (GPs’) views and experiences of providing postnatal care

ObjectivesDevelop an understanding of the views and experiences of general practitioners (GPs) about their role in postnatal care, including barriers and facilitators to good care, and timing and content of...

The opinions of GDPs on the challenges of managing tooth wear in primary dental care.

As patients access most of their dental care within the primary care setting, it is relevant to consider how the experience and opinions of general dental practitioners (GDPs) influence the diagnosis, monitoring and treatment of their patients with tooth wear. This paper records the agreed outcomes of semi-structured discussions with three experienced GDPs. The aim is to continue the broader debate about how patients with tooth wear currently are and ideally could be managed within the primary care settings in England. The outcomes are also likely to be applicable to other countries, regardless of the local funding models for routine patient care.

Increasing the chance of dying at home: roles, tasks and approaches of general practitioners enabling palliative care: a systematic review of qualitative literature

BackgroundMany elderly people wish to die at home but end up dying at the hospital. If the patient wishes to die at home, palliative care provided by General Practitioners (GPs) may increase the chance of dying at home, however, there is a lack of knowledge on how GPs should provide palliative care. We aimed to identify roles, tasks and approaches of GPs enabling palliative care, by exploring the experiences of GPs, other healthcare professionals, patients, and relatives through a systematic review of the qualitative literature.MethodsWe searched PubMed, EMBASE, PsycINFO, Web of Science, and CINAHL in March 2022. Thematic analysis was used for synthesizing the results.ResultsFour thousand five hundred sixty three unique records were retrieved, and 12 studies were included for review. Of these, ten were interview or focus group studies and two were survey studies with additional open-ended questions. Only qualitative findings from the studies were used in synthesizing the results. Thematic analysis produced four main themes describing the roles, tasks and approaches of GPs enabling palliative care to increase the chance for patients to die at home. GPs can support patients in the final phases of life by applying a holistic, patient-centred, and proactive approach to palliative care and by having sufficient education and training. Furthermore, the palliative care consultation should include symptom management, handling psychosocial and spiritual needs, maintaining a fragile balance, and proper communication with the patient. Lastly, GPs must address several palliative care elements surrounding the consultation including initiating the palliative care, being available, being the team coordinator/collaborator, providing continuous care and having sufficient knowledge about the patient.ConclusionsThe roles, tasks and approaches of the GPs enabling palliative care include being aware of elements in the palliative care consultation and elements surrounding the consultation and by having sufficient education and training and a broad, proactive, and patient-centred approach.

Two years of approved digital health applications in Germany – Perspectives and experiences of general practitioners with an affinity for their use

BackgroundSince 2020, physicians in Germany can prescribe approved digital health applications (DHAs) with the costs covered by the health system. There has so far been a lack of studies on attitudes and experiences amongst GPs in using DHAs.ObjectivesThe aim was to elucidate the experiences and observations of GPs that have used DHAs in health care and to examine the conditions necessary for DHAs to gain a foothold in primary care according to the GPs.MethodsIn 2022, 96 qualitative semi-standardised interviews were conducted with German GPs with experience in prescribing DHAs. The GPs were all organised in digitalisation-oriented physicians’ associations. Fifty-four interviews were carried out in person and 42 by phone. The data were analysed according to qualitative content analysis.ResultsUnlike health apps, the interviewees saw DHAs as reliable tools for enhancing the relationship between GPs and their patients. They saw the DHAs they had been prescribing as useful and reported various benefits, including improvements in compliance, mobility, information for patients and weight reduction. The physicians also saw room for further improvement (usability, gamification, training, information sources). Interviewees saw the inclusion of DHAs in evidence-based guidelines as a major step forward.ConclusionThe interviewees rated DHAs favourably regarding healthcare potential and as safer and more reliable than conventional health apps. Many saw benefits to healthcare from using such applications. From the interviewees’ point of view, DHAs can be integrated more effectively into patient care.

Anti-Doping Knowledge, Attitude, and Experience of General Practitioners in Kenya

General practitioners are regarded as athletic support personnel as they are involved in delivering supportive services such as treating athletes participating in or preparing for sports competitions. General practitioners play a vital role in influencing athletes to fulfill their mandate to adhere to clean sports and therefore, their additional knowledge in sports is required to comprehensively address their health needs without affecting the integrity of rules that govern fair play. General practitioners require sufficient doping knowledge to provide athletes with health needs consistent with anti-doping regulations. In Kenya, no studies have investigated or reported the doping knowledge, attitude or experience of General Practitioners, thus leaving a knowledge gap on their ability to treat competitive athletes harmonious with WADA requirements. Therefore, the study sought to unearth General Practitioners' doping knowledge, attitude, and experience in Kenya. The study's findings have implications on doping knowledge, attitude, and experience of Kenya General Practitioners’ essential to inform the current status of the concept. A cross-sectional analytical study design was selected because of its robustness in describing general practitioners' current doping knowledge, attitude, and experiences. Data was collected using a self-reported and validated questionnaire where 250 General practitioners completed the survey. Findings revealed that Kenyan general practitioners are well aware of doping regulatory agencies of WADA and ADAK. The findings demonstrated that General Practitioners had an average doping knowledge (47.77 ± 14.03) punctuated with limited knowledge of prohibited substances, methods, and substances in certain sports. Work experience significantly influenced General Practitioners knowledge, F (4,245) = 10.852, p< .001. General Practitioners had a negative doping attitude of 45.23 ± 13.64. As many as 22% (55) General Practitioners received doping requests for the last 12 months, where 35.7% (89) of requests are about drugs to aid recovery. Anabolic steroids, corticosteroids, and peptide hormones were among the most sought-after PEDs. General Practitioners in Kenya have inadequate doping knowledge, which could limit their efficacy in treating professional athletes in line with WADA guidelines. Additional anti-doping training could benefit them address this limitation. Although General Practitioners demonstrated a negative attitude, expanding their involvement through active participation in doping seminars, and programs can enhance their understanding of the doping concept necessary to develop and maintain a strong negative attitude.

Exploring the experiences of general practitioners working with patients who use performance and image enhancing drugs

ObjectiveMedical practitioners such as general practitioners (GPs) may have an underutilized role when it comes to addressing the associated harms among people who use performance and image enhancing drugs (PIEDs) such as anabolic androgenic steroids (AAS). However, consumers report not accessing this group due to the perception they lack knowledge, and medical practitioners often report having a negative view of this group. The aim of this study was to investigate the experiences of Australian GPs with patients who use PIEDs such as AAS MethodA purposive sample of participants was recruited via research contacts and strategic announcements through GP groups and medical boards. Participants were also recruited through snowball sampling. Interviews were conducted online. A semi-structured interview schedule was utilised. The data were analysed thematically using an inductive approach. FindingsSix participants were recruited. Three themes emerged; these were: (1) Knowledge, support and training, challenges: “Better prepared than what I am”; (2) Ethical conflicts: “The difficulty lies in the conflict”; and (3) Poly drug use: “It's a bit intersectoral”. ConclusionsGPs feel inadequately prepared to provide services to this unique cohort of substance consumers and suggest there are specific challenges which intersect with ethics and legality, which make this an even more complex cohort. PIED consumers which access GPs may also be engaging in polysubstance use, although the temporal order of this relationship is still unclear.

Students’ and tutors’ experiences of remote ‘student–patient’ consultations

Background Remote consulting has become part of the medical student clinical experience in primary care, but little research exists regarding the impact on learning. Aim To describe the experiences of General Practitioner (GP) educators and medical students in using student-led remote consultations as an educational tool. Method A qualitative, explorative study conducted at four UK medical schools. GP educators and medical students were purposively sampled and interviewed. Results Nine themes arose: practical application, autonomy, heuristics, safety, triage of undifferentiated patients, clinical reasoning, patient inclusion in student education, student–patient interaction, and student–doctor interaction. Discussion Remote consulting has become part of the clinical placement experience. This has been found to expose students to a wider variety of clinical presentations. Verbal communication, history-taking, triage, and clinical reasoning skills were practised through remote consulting, but examination skills development was lacking. Students found building rapport more challenging, although this was mitigated by having more time with patients. Greater clinical risk was perceived in remote consulting, which had potential to negatively impact students’ psychological safety. Frequent debriefs could ameliorate this risk and positively impact student–doctor relationships. Student autonomy and independence increased due to greater participation and responsibility. Pre-selection of patients could be helpful but had potential to expose students to lower complexity patients. Practice points Remote consulting confers unique educational benefits. Remote consulting can help develop history-taking and communication skills, as well as clinical reasoning skills. The psychological safety of the student and the supervisory risk of the tutor can be impacted by remote consulting, but frequent debriefs between the student and tutor can help mitigate this risk. Learning how to conduct remote, and face-to-face consultations is important in medical education.

Perspectives of Dutch women on premenstrual disorder. A qualitative study exploring women’s experiences

BackgroundWomen presenting with Premenstrual Disorder (PMD) to general practitioners (GPs) experience problems with their biopsychosocial functioning. PMD is a disorder consisting of physical and/or mood-based symptoms cyclically occurring with a significant impairment of daily life. Little is known about the symptoms and coping strategies of women with PMD and their experiences with their GPs.ObjectivesThis present study aimed to improve understanding of the perspectives of women with PMD, their coping strategies and their expectations of the GP.DesignQualitative study with semi-structured interviews.SettingIn 2017, Dutch women with symptoms of premenstrual disorder were recruited through local newspapers in the town of Nijmegen and the North-Holland region and via social media. After checking the inclusion and exclusion criteria, we interviewed 20 women (between 27 and 49 years of age). The interviews took place at a location of the interviewees’ preference.ResultsPMD symptoms can strongly influence the quality of women’s lives. Three themes emerged from our analysis: feelings of having two separate female identities, PMD as a life-controlling condition and different coping strategies. Most women used an active coping strategy. Women with PMD need recognition from their GPs and knowledge of proper treatment.ConclusionPMD symptoms can have a high impact on daily life. Women with PMD expressed their need for acknowledgement and a personalised approach from their GP. Greater awareness and knowledge among GPs may be helpful in this.

Supporting GPs and people with hypertension to maximise medication use to control blood pressure: Protocol for a pilot cluster RCT of the MIAMI intervention

Background: Hypertension is one of the most important risk factors for stroke and heart disease. Recent international guidelines have stated that 'poor adherence to treatment – in addition to physician inertia - is the most important cause of poor blood pressure control'. The MaxImising Adherence, Minimising Inertia (MIAMI) intervention, which has been developed using a systematic, theoretical, user-centred approach, aims to support general practitioners (GPs) and people with hypertension to maximise medication use, through the facilitation of adequate information exchange within consultations about long-term antihypertensive medication use and adherence skill development. The aim of the MIAMI pilot cluster randomised controlled trial (RCT) is to gather and analyse feasibility data to allow us to (1) refine the intervention, and (2) determine the feasibility of a definitive RCT. Methods: GP practices (n = 6) will be recruited and randomised to the intervention arm (n = 3) or usual care control arm (n = 3). Each practice will recruit 10 patient participants. For a patient to be eligible they must have a diagnosis of hypertension, be on two or more anti-hypertensive medications, must not be achieving recommended blood pressure levels, and be over the age of 65 years. Participants in the intervention arm will meet their GP and receive the MIAMI intervention twice over three months. Quantitative data collection will take place at baseline and three month follow up. A pilot health economic analysis and a qualitative sub-study will also be incorporated into the study. Discussion: This pilot cluster RCT of the MIAMI intervention will allow us to gather valuable acceptability and feasibility data to further refine the intervention so it optimally designed for both GP and patient use. In particular, the qualitative component will provide an insight into GP and patient experiences of using the intervention.

A national Delphi study: experiences of general practitioner (GP) trainees in the Republic of Ireland undertaking online small group learning as part of the GP Training Programme during COVID-19.

During the COVID-19 pandemic, GP training day release was redirected from face-to-face to an online setting. With this study, our aim was to assess trainee experiences of online small group learning and to make recommendations with regards to future GP training. A qualitative study using the Delphi survey technique, approved by the Irish College of General Practitioners (ICGP) Ethics Committee. A series of three sequential online questionnaires were sent to our trainee cohort in all 14 training schemes in Ireland. The first questionnaire explored GP trainee experiences and key themes were generated. Subsequent questionnaires were developed using these themes, with second and third round questionnaires establishing consensus on these experiences. In total, 64 GP trainees responded. Each training scheme was represented. Response rates for round 1 and 2 were 76% and 56% respectively, with round 3 currently underway. Trainees felt that online teaching was convenient, reduced commuting costs, and provided peer support. They also reported loss in unstructured discussion, practical teaching sessions and relationship building. Seven key themes were generated: future format of GP training; accessibility and flexibility; teaching experience; provision of GP training; support and collegiality; educational experience; and technical problems. There is a consensus that some online teaching should be retained for the future. Online teaching provided a continuation in training that was more convenient and accessible but affected social interactions and relationship building amongst trainees. Future online sessions could be utilised in a hybrid model of teaching going forward.

'Attorneys of the Poor': the lived experience of general practitioners working in disadvantaged parts of rural Ireland.

The experience of structural violence impacts not only patients but also GPs who deliver their primary care. Farmer (1999) claims that 'sickness due to structural violence results from neither culture nor pure individual will, but historically given and economically driven processes and forces that conspire to constrain individual agency'. I aimed to explore qualitatively the lived experience of GPs in remote rural areas who cared for disadvantaged populations selected from the Haase-Pratschke Deprivation Index (2016). I visited ten GPs in remote rural areas, did semi-structured interviews, explored the hinterland of their practices and observed the historical geography of their locality. In all cases, interviews were transcribed verbatim. NVivo was used for thematic analysis using Grounded Theory. Findings were framed in the literature around postcolonial geographies, care and societal inequality. Participants were aged from 35 years to 65 years; half were women and half were men. Three main themes emerged: GPs value their lifeworld; they feel at high risk from over-work, inaccessible secondary care for patients and under-acknowledgment of their work; and they experience satisfaction in providing lifelong primary care. They fear that difficulties recruiting younger doctors may terminate the continuity of care that creates a sense of place. Rural GPs are linchpins of community for disadvantaged people. But GPs suffer the effects of structural violence and feel alienated from being their personal and professional best. Factors to consider are the roll-out of the Irish government's 2017 healthcare policy, Sláintecare, changes wrought by the COVID-19 pandemic in the Irish healthcare system and poor retention of Irish-trained doctors.

Celiac disease: experience of general practitioners in Brianza Area- Monza- Milan-Italy.

The purpose of the study was to better investigate the degree of knowledge and the diagnostic approach concerning celiac disease and its extra-intestinal manifestations by general practitioners in Italy. Celiac Disease is a common chronic disease, but often goes undiagnosed because of atypical symptoms or silent disease. Currently there are non-definitive data about the disease management approach concerning celiac disease by general practitioners. To better investigate the degree of knowledge and the diagnostic approach concerning celiac disease and its extra-intestinal manifestations, questionnaire was used to assess the daily practice of diagnosis, treatment, and follow-up of this condition by general practitioners in two densely populated area in Italy: Monza-Brianza Area and Milan City. The questionnaire was composed of 18 questions that explored 3 precise domains: diagnosis criteria, correct management of celiac disease and availability for training. The frequencies of the domains explored were analyzed, analyzes were carried out to identify differences between the groups of general practitioners interviewed. Analysis of the questionnaires showed a degree of knowledge and preparation comparable to that of other countries, even though not sufficient to guarantee access to early diagnosis for all patients with celiac disease. The knowledge was not influenced by the years of experience or specific curriculum of health professionals. General practitioners under 40 were much more in favor of continuous training and were aware of its importance (OR=10.55; CI95%: 1.62-445.39), although this need was a high priority in the whole group interviewed (84.7%). Continuous specific training aimed at primary care physicians and general practitioners is the first tool to improve early diagnosis. A second opportunity is represented by the continuous dialogue between general practitioners and tertiary level hospitals and universities.

Molar Incisor Hypomineralization: Current Knowledge, Clinical Experience, and Perception among General Dental Practitioners, Pediatric Dentists, and Other Dental Specialists in Northern India – A Cross-sectional Study

Background: Molar incisor hypomineralization (MIH) is the hypomineralization of systemic origin of one to four permanent first molars, frequently associated with affected incisors. It is presented as demarcated enamel opacities of different colors, occasionally undergoing posteruptive breakdown. The characteristic feature of MIH is the clear demarcation between the affected and sound enamel. There is an asymmetry of defects present in the molars and incisors where one molar or incisor can be severely affected, while the contralateral tooth may be clinically sound or have only minor defects. Aim: The study aimed to assess and compare the knowledge, perceptions, and clinical experience of general dental practitioners (GDPs), pediatric dentists (PDs), and other dental specialists (DSs) in Northern India about MIH. Methodology: Online survey methods were used to collect the responses from Northern Indian dentists regarding their knowledge and perceptions about MIH. The survey tool focused on participants’ sociodemographics, clinical experience, perceptions, clinical management, and preferences for further training. The level of knowledge regarding MIH was compared among the three groups. Data analysis utilized Chi-square and one-way analysis of variance followed by Tukey’s post hoc test using SPSS Statistics version 26. Results: The majority of respondents had observed MIH in their practice (77.3%). The participants who had a postgraduate degree had a significantly higher knowledge score value than GDPs (P < 0.001). Conclusion: Dissemination of evidence on MIH to dental practitioners, especially to GDPs, is highly needed to assure confidence in MIH diagnosis at an early stage when it can be best managed.

Reflections of Australian general practitioners during the first year of the COVID-19 pandemic: a qualitative study.

General practitioners (GPs) have played an integral role in Australia's coronavirus disease 2019 (COVID-19) pandemic response. However, little is known about how GPs themselves have been impacted by the COVID-19 pandemic. This study aimed to increase our understanding of the experiences of GPs working during the COVID-19 pandemic. A qualitative study was conducted using semi-structured interviews. Using purposive sampling, 15 GPs from South-Eastern Australia were asked to reflect on their experiences during the first year of the COVID-19 pandemic. Interview transcripts underwent thematic analysis. Five main themes were identified: fear of infection; uncertainty and information overload; impacts on the government-GP relationship; impacts on the patient-doctor relationship; and teamwork within practices and among GPs. The 15 GPs interviewed in this study provided valuable insights into their experiences working during the first year of the COVID-19 pandemic. From these insights, four recommendations propose what could be done to help support GPs to respond to a pandemic while continuing to deliver primary health care.

Communicating medical information with Aboriginal patients: lessons learned from GPs and GP registrars in Aboriginal primary health care.

Aboriginal culture stands as the oldest continuous culture in the world. It gives paramount importance to a harmonious balance between personal connections to the body, spirit, and mind, as well as collective relationships with family, land, and community, integral to the wellbeing of Aboriginal people. However, obstacles can emerge for patients due to language barriers, cultural differences, or a historical lack of trust in the healthcare system. The establishment of Aboriginal Community Controlled Health Organisations (ACCHOs) has undoubtedly improved the healthcare experience for Aboriginal patients, yet there is limited research on the specific approaches utilised by general practitioners (GPs) working in these clinics. Twelve semi-structured interviews were conducted with two groups of GPs working in Aboriginal health. Each GP was presented with three scenarios and asked questions related to each scenario. Braun and Clarke's method of thematic analysis was applied to transcribed interviews. Patient-doctor relationship, health literacy, and engagement with the health system emerged as key factors influencing communication with Aboriginal patients. Experienced GPs, despite differing clinical backgrounds, shared concise yet similar ideas to their less experienced counterparts. Notably, experienced GPs prioritised non-medical conversations and mindful body language, emphasising the importance of building strong patient relationships over other consultation aspects. This research provides initial insights for GPs in Aboriginal health, comparing experienced GPs with more than 10years experience to novices. However, further research involving Aboriginal patients is needed to validate GP strategies and understand their significance from the patients' perspective.

Recognition and treatment of mild cognitive impairment in Serbian general practice

Introduction/Objective. Mild cognitive impairment (MCI) is a state of progressive cognitive decline, rarely recognized by general practitioners (GPs), which is a reason of late treatment and fast progression towards more serious conditions. The main obstacles for the timely treatment of MCI are lack of diagnostic protocols and clinical guidelines as well as lack of knowledge and disbelief in the pharmacological therapeutic possibilities. The aim of this investigation was to assess level of recognition of MCI symptoms by GPs, and to estimate their perception of distinct risk factors significance for MCI development. Methods. Participants of the ?Days of General Medicine? Conference (Serbia, March 2018), n = 340, completed 12 items questionnaire about recognition and treatment of the MCI patients. We have used descriptive statistics, ?2, Mann?Whitney U tests, binary logistic regression analysis for results presentation, sub-groups comparison, to assess predictors of drug therapy selection, respectively. Results. Study showed GPs recognize diabetes as most important factor for MCI, then hypercholesterolemia, smoking and sedentary behavior, while hypertension and obesity are perceived as less important. Those GPs who estimated diabetes and hypercholesterolemia as more important for all patients are significantly more prone to prescribe symptomatic therapy (pentoxifylline and vinpocetine), p < 0.05 according to ?2 test. Logistic regression analysis regarding therapy predictions showed that years of GP experience is the most important predictor of drug therapy selection (p < 0.01). Conclusion. Results of this investigation pointed a need for MCI education for young physicians, in order to improve diagnosis and treatment of these patients.

Cancer detection during the COVID-19 pandemic-Experiences in primary care and recommendations for the future.

To describe general practitioners (GPs) experiences with the impact COVID-19 on the duration of cancer detection. Cross-sectional survey study among Dutch GPs. Fifty-eight GPs participated. During the first wave, COVID-19-related delays were experienced by 88%, 52%, and 67% of GPs in the contact-seeking, primary care, and referral phases, respectively. GPs reported delays due to telehealth consultations, longer waiting times and patient's concerns of COVID infections and overburdening GPs. The majority of GPs experienced delays in cancer diagnostic processes during the beginning of the COVID pandemic, which was most prominent in the timeliness in which patients sought GP care.

Role of multidimensional factors in the diagnosis and treatment of tonsillopharyngitis in primary care: a qualitative study

BackgroundTonsillopharyngitis is one of the most frequently observed upper respiratory tract infections, for which antibiotics are prescribed in ambulatory care. In most cases, tonsillopharyngitis is benign and self-limiting, mostly a viral condition. The aim of this study was to explore the diagnostic and treatment process of tonsillopharyngitis by general practitioners and to understand decisions regarding antibiotic prescribing and the factors that shape these practices.Methods/designThis was a qualitative interview study in primary care practices in Latvia. Semi-structured face-to-face interviews were conducted with general practitioners from November 2016 to January 2017. Thematic analysis was applied to identify factors that influence the prescribing practice in a primary care setting in conjunction with a specific context in which the prescriber practices.ResultsDecisions and practice of general practitioner are not static over time or context; they occur within an environmental setting influenced by individual factors of general practitioners, the health care system, and practice-specific factors that shape the diagnosis and antibiotic prescribing in the tonsillopharyngitis. Interviewed general practitioners rely primarily on their personal experience, perception, and skills acquired in their practice, which are encouraged by the environment, where the necessary tools and resources are not in place to encourage rational prescribing of antibiotics.ConclusionsGeneral practitioners’ decision regarding antibiotic prescribing is an unstable concept that differs between prescribers. The health care system could augment the experience of general practitioners through structural changes such as guidelines, availability of antibiotics, and available antibiotics package size.