Deliberate departures from good general practice: a study of motives among Dutch general practitioners.
BACKGROUND
When general practitioners (GPs) act contrary to their own standards of good practice, they usually cite patient demands as the main reason. However, up until now, studies have relied on doctors' recollections of departures from their own norms, which may be unreliable.


OBJECTIVE
To systematically explore GPs' motives for deliberate departures from their own conception of good practice.


METHODS
Forty-nine GPs, over five days, registered to what extent they had deviated from their own norms, and recorded the motives underlying any deviation.


RESULTS
Of the 6087 consultations registered, 10% contained some departure from 'good' general practice, the majority (75%) of which was perceived by the doctor concerned as 'slight'. Doctors underpinned their departures mostly by referring to the doctor-patient relationship: the wish to be nice was used, on average, in 42% of deviations, and the wish to prevent a conflict in 30%. The most important non-relational motive was clinical uncertainty, which doctors used in 11% of their cases.


CONCLUSIONS
Contrary to common belief, GPs often comply with patient requests because they wish to, and not because they feel forced to. Whether or not this behaviour affects the quality of care is largely dependent on the model of 'good' general practice used.
Veldhuis
M
M
Department of General Practice, Academic Medical Centre, Amsterdam.
Wigersma
L
L
Okkes
I
I
D005194:Family Practice / Q000592:standards*; D006801:Humans; D009042:Motivation; D010817:Physician-Patient Relations; D010821:Physicians, Family / Q000523:psychology; D011787:Quality of Health Care; D012017:Referral and Consultation