Managing demand for primary care

Why do people consult doctors? At first glance because they feel unwell. However research suggests that the reasons are far more complex than that. Innovators also know that the answer to this question is vital for those seeking an agile, intuitive, creative and cheap solution to the demand for their services. Theories predict the consultation habits of many patients. I especially like this summary:

The overall prevalence of symptoms in the community is not closely related to general practice consultation rates, and the consulting population is a selected population of those who are in need of medical care. The literature reviewed suggests that poor health status, social disadvantage poor social support and inadequate coping strategies are associated with higher consultation rates. Some populations subgroups may experience particular barriers to seeking care. Campbell and Roland

Innovators might also ask why are those patients sitting in my waiting room? I remember a hoary old tale of a doctor who was feeling especially grumpy one day and stormed through the waiting room announcing that anyone who thought they had a ‘real’ problem should stay everyone else should go home- half the waiting room emptied.

It seems quite a few people who go to doctors will have symptoms- however a proportion will be back there by invitation. How big a proportion and why have they been invited back? There are many reasons to schedule a repeat appointment. It conveys the notion that the patient will be harmed if they don’t see a doctor on a given day for one or more of these reasons:

1. Their response to treatment is unpredictable and the dose or drug may need to be revised

2. They have a condition that can’t be diagnosed or may progress or need additional measures by a specified date

However other reasons for requesting a review include:

1. The doctor isn’t confident that the diagnosis is correct and wants a chance to review the advice issued.

2. The patient is required by someone (e.g. an employer) to produce evidence of a visit to a doctor

3. A full waiting room ensures the doctor looks busy for whatever other reason.

4. The doctor needs to reinforce the impression that the condition has been taken seriously.

The time cost for doing everything that could possibly be recommended for patients with chronic conditions  has been shown to be untenable. Either the guidelines are wrong or a different solution needs to be found for at least some of these people. What is the evidence for asking a patient to return within a week or two with a specific new condition and within a month with a longstanding condition?

There is a need to be proactive in some cases. However is it possible that we encourage people to attend for review appointments when there is a low probability that they will benefit? Are there other reasons to fill the waiting room?

6 thoughts on “Managing demand for primary care”

  1. Ensure every contact has expected outcome recorded, such as 20% less pain within 3 days, if starting buprenorphine patch. Have software always bring up last visit notes and require edit before anything can be done, such as +/- dispensed, +/- used, +/- worked as anticipated (tick boxes.) This extra job would pay handsomely in self education, for the time involved. This needs trialling, with the hypothesis it would improve physician and client behaviours, outcomes.

  2. I have often wondered about the evidence for regular GP management plan reviews. The ones who come back are usually the compliant ones who are managing their chronic disease well and I don’t think it is the review that makes a difference but the personality of the patient.
    It is like the health checks it is often the healthy ones who come for checks.

  3. When I’m in the waiting room, I’m striving to be healthy, and there is a great opportunity to educate me. There was also a time when I attended regular because I was defeated by the illness, and felt I had to go. Until I knew what was wrong AND had a belief I could recover, I kept coming, but with little window for improvement. Do we routinely ask patients if they really believe they can recover?

Leave a Reply

Your email address will not be published. Required fields are marked *