Understanding patient worries about wasting medical time

If you have ever wondered whether or not your visit to the doctor was really necessary, you are certainly not alone. Studies in the UK have repeatedly shown that worries about ‘wasting the doctor’s time’ are one factor influencing patients’ decisions about whether or not to make a medical appointment. Our work is the first study devoted entirely to this subject which finds that many patients of all ages, healthy or with several chronic conditions, wonder whether or not their symptoms are worthy of the doctor’s time. Our study was set up to explore patients’ experiences in primary care. When we carried out video-elicitation interviews with patients in order to explore their responses following consultations with their doctor, worry about timewasting turned out to be such a prominent feature of their accounts that we decided to study this phenomenon separately.

Trying to understand factors that influence our decisions to see the doctor is important. We are reminded, on the one hand, that it is vital to treat illness early so as to ensure a prompt return to health and avoid complications. Patients with symptoms which could indicate cancer are particularly urged to see their doctor early, and the Be Clear on Cancer Campaign has worked hard to spread this message. On the other hand, we are frequently reminded, especially through the winter months, that many symptoms will come and go of their own accord without requiring input from the doctor. Posters in doctors’ waiting rooms reinforce this message. So how do we make sense of this advice? How do we judge whether symptoms may be early signs of potentially serious disease, or whether they can be managed at home and will soon settle?

Doctors have a long history of expressing frustration with patients’ consulting unnecessarily, and tacit moral labelling of patients has been repeatedly described. Our work shows that this struggle to successfully adopt a ‘reasonable consulting behaviour’ resonates in patients’ experiences of interaction with the healthcare system and of negotiating their entitlement to be seen by the doctor, leaving many of them wondering whether their ailments are indeed worthy of medical time. Patients speak spontaneously about striving to consult ‘only when absolutely necessary’, and yet neither patients (in our interviews) nor doctors (in the literature) are able to clearly define what constitutes an ‘absolutely necessary’ reason to consult. Increasing demand on services and lack of available appointments exacerbate this feeling.   We consider the management of minor illness in the history of UK general practice and how this might impact on patients’ worry about timewasting. Minor illness is generally deemed by the doctor to not require medical input. However, presenting to the doctor with symptoms of minor illness may be the first step in disclosing more serious complaints. General practice grapples with the challenge of committing itself to the practice of holistic medicine on the one hand, and performing its duty of triage and gatekeeping on the other.

The result, in a system where time is a precious good in short supply, is that some presentations become somehow more deserving than others. Whilst we do know that worry about timewasting has been reported in other countries, we consider whether the particular structure and funding of our healthcare system may be more prone to engender such feelings, and whether an NHS in crisis – with increasing workloads for GPs and dwindling professional morale – is likely to exacerbate this tendency. Our work indicates that moral evaluations which doctors and society bring to bear upon patients feature strongly in some patients’ accounts of their healthcare experience. We go on to suggest that the notion of candidacy can help us to acknowledge and clarify this search for legitimacy in patients’ journeys through the health service as they seek to negotiate their entitlement to medical time.  In doing so, candidacy offers a helpful framework in which social, political, and moral dimensions of help-seeking are rendered explicit.

For full details, see:

Llanwarne N, Newbould J, Burt J, Campbell J L, and Roland M. Wasting the doctor’s time? A video-elicitation interview study with patients in primary care. Social Science and Medicine 2017 DOI: 10.1016/j.socscimed.2017.01.025

 

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