General practitioners' experiences with out-of-hours cardiorespiratory consultations: a qualitative study

Angel M. R. Schols*, Tessa A. van Boekholt, Lex M. R. Oversier, Geert-Jan Dinant, Jochen W. L. Cals

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

Abstract

Objectives: To explore general practitioners' (GPs') experiences with and views on the diagnosis and management of patients with cardiorespiratory symptoms during GP out-of-hours care. We also aimed to identify ways of (diagnostic) support during these consultations. Design: Qualitative study; face-to-face semistructured interviews. Setting: GP out-of-hours care in the Netherlands. Participants: 15 GPs in the province of Limburg, the Netherlands. Results: Overall, GPs find cardiorespiratory consultations challenging and difficult. Tension and uncertainty as well as defensive behaviour were the key themes that characterised GPs' experiences. We identified several subthemes underlying the key themes: setting, potentially severe consequences, absence of a pre-existing relationship and little knowledge of the patient's background, difficulties differentiating between possible causes of symptoms, changed public opinion and patient population, and previous experiences. GPs approach cardiorespiratory consultations differently and their threshold for referring patients and performing diagnostic tests is lower. We identified differing views on the use of additional diagnostic tests at GP out-of-hours services. Conclusions: This study sheds further light on how GPs experience cardiorespiratory consultations during out-of-hours care and how this leads to a high number of cardiorespiratory referrals. GPs relate cardiorespiratory consultation during out-of-hours care with tension and uncertainty leading to defensive behaviour, which can be translated into a different approach towards cardiorespiratory consultations and a lower threshold for referring patients and performing diagnostic tests. Opinions on the possible added value of additional diagnostics in reducing the number of referrals should be further investigated, as we identified differing views on the use of additional diagnostic tests at GP out-of-hours services.
Original languageEnglish
Article numbere012136
JournalBMJ Open
Volume6
Issue number8
DOIs
Publication statusPublished - 2016

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