title: The patient, the doctor, and the patient's loyalty: a qualitative study in French general practice.
abstract: BACKGROUND
  The term loyalty can be defined as the attachment that characterises someone who consistent in their feelings, affections, or habits. By introducing the Declaration of General Practitioner (or preferred doctor declaration) in 2004, France adopted a formal incentive for patients to be faithful to their doctor since it entailed optimal coverage of medical care by their national health insurance There has been no research evaluating the impact of this measure and to determine the components of doctor-patient loyalty.
  
  
  OBJECTIVE
  To explore what builds and maintains patients' loyalty to their GP.
  
  
  METHODS
  Qualitative study based on semi-structured interviews close to Paris (the département of Yvelines'), France.
  
  
  METHODS
  Twenty-eight patients were interviewed in five surgeries of self-employed GPs with different demographics. Interviews were transcribed and a thematic analysis conducted to categorise the data. Phenomenological analysis was used to analyse the transcripts.
  
  
  RESULTS
  Patient loyalty is based mainly on trust. Trust can be reinforced by certain comforting factors such as the ability to listen, a sense of carefulness, and the quality of care. Loyalty is both a dynamic construct and a relational exchange subject to various influences. Patients find advantages in being loyal. The model of the 'family doctor' has always been the archetype of loyalty for several generations within one family. A GP's inability to meet all of the patient's requirements is not necessarily a determining factor in breaking the patient's loyalty.
  
  
  CONCLUSIONS
  Loyalty is more complex than commonly assumed and involves dimensions of trust, listening, quality of care, availability, and familiarity. The observations drawn out from this study warrant a larger scale investigation.
authors: Department of Family Medicine, Faculty of Health Sciences Simone Veil, University Versailles Saint-Quentin en Yvelines, Montigny-le-Bretonneux, France.
authors: Laura
authors: L
authors: Gérard
authors: Department of Family Medicine, Faculty of Health Sciences Simone Veil, University Versailles Saint-Quentin en Yvelines, Montigny-le-Bretonneux, France and University Paris-Saclay, CESP INSERM (U1018), Team 1: 'Health services research' Villejuif, France.
authors: Mathilde
authors: M
authors: François
authors: Department of Family Medicine, Faculty of Health Sciences Simone Veil, University Versailles Saint-Quentin en Yvelines, Montigny-le-Bretonneux, France.
authors: Marine
authors: M
authors: de Chefdebien
authors: Department of Family Medicine, Faculty of Health Sciences Simone Veil, University Versailles Saint-Quentin en Yvelines, Montigny-le-Bretonneux, France and University Paris-Saclay, CESP INSERM (U1018), Team 1: 'Health services research' Villejuif, France.
authors: Oliver
authors: O
authors: Saint-Lary
authors: Department of Family Medicine, Faculty of Health Sciences Simone Veil, University Versailles Saint-Quentin en Yvelines, Montigny-le-Bretonneux, France.
authors: Alain
authors: A
authors: Jami
mesh_terms: D000328:Adult; D001291:Attitude of Health Personnel; D003266:Continuity of Patient Care / Q000458:organization & administration* / Q000706:statistics & numerical data; D005260:Female; D058006:General Practice / Q000458:organization & administration; D006801:Humans; D019458:Insurance Coverage / Q000706:statistics & numerical data*; D007348:Insurance, Health / Q000706:statistics & numerical data*; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D010297:Paris / Q000453:epidemiology; D017060:Patient Satisfaction / Q000706:statistics & numerical data*; D010817:Physician-Patient Relations; D036301:Qualitative Research; D011787:Quality of Health Care / Q000458:organization & administration* / Q000592:standards; D035502:Trust
keywords: continuity of patient care; doctor–patient relations; general practice; qualitative research; trust