Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress 2023 EHA Congress 2023 ASCO Annual Meeting
Clinical Collections
Advances in Alzheimer’s

At a glance: The ONWARDS insulin icodec trials

A round-up of the ONWARDS phase 3 clinical trials evaluating the novel weekly insulin icodec in people with diabetes.
ADVANCED SEARCH
Log in
Top
BMC Primary Care
Published in: BMC Primary Care 1/2014

Open Access 01-12-2014 | Research article

Understanding “revolving door” patients in general practice: a qualitative study

Authors: Andrea E Williamson, Kenneth Mullen, Philip Wilson

Published in: BMC Primary Care | Issue 1/2014

Login to get access

Abstract

Background

‘Revolving door’ patients in general practice are repeatedly removed from general practitioners’ (GP) lists. This paper reports a qualitative portion of the first mixed methods study of these marginalised patients.

Methods

We conducted qualitative semi-structured interviews with six practitioner services staff and six GPs in Scotland, utilizing Charmazian grounded theory to characterise ‘revolving door’ patients and their impact from professionals’ perspectives.

Results

‘Revolving door’ patients were reported as having three necessary characteristics; they had unreasonable expectations, exhibited inappropriate behaviours and had unmet health needs. A range of boundary breaches were reported too when ‘revolving door’ patients interacted with NHS staff.

Conclusions

We utilise the ‘sensitising concepts’ of legitimacy by drawing on literature about ‘good and bad’ patients and ‘dirty work designations.’ We relate these to the core work of general practice and explore the role that medical and moral schemas have in how health service professionals understand and work with ‘revolving door’ patients. We suggest this may have wider relevance for the problem doctor patient relationship literature.
Appendix
Available only for authorised users
Literature
1.
Gillies JCM, Mercer SW, Lyon A, Scott M, Watt GCM: Distilling the essence of general practice: a learning journey in progress. Br J Gen Pract. 2009, 59: 356-363.CrossRef
2.
Bower P, Gask L, May C, Mead N: Domains of consultation research in primary care. Patient Educ and Counselling. 2001, 45: 3-11. 10.1016/S0738-3991(01)00117-3.CrossRef
3.
Groves JE: Taking care of the hateful patient. N Engl J Med. 1978, 298 (16): 883-887. 10.1056/NEJM197804202981605.CrossRefPubMed
4.
O'Dowd TC: Five years of heartsink patients in general practice. Br Med J. 1988, 297: 528-530. 10.1136/bmj.297.6647.528.CrossRef
5.
Mathers NJ, Jones N, Hannay D: Heartsink patients: a study of their general practitioners. Br J Gen Pract. 1995, 45 (395): 293-296.PubMedPubMedCentral
6.
Smits FT, Wittkampf KA, Schene AH, Bindels PJE, Van Weert HCPM: Interventions on frequent attenders in primary care. Scand J Prim Health Care. 2008, 26 (2): 111-116. 10.1080/02813430802112997.CrossRefPubMedPubMedCentral
7.
8.
Fink P, Rosendal M: Recent developments in the understanding and management of functional somatic symptoms in primary care. Current Opinion in Psychiatr. 2008, 21: 182-188. 10.1097/YCO.0b013e3282f51254.CrossRef
9.
Kirmayer LJ, Groleau D, Looper KJ, Dominice Dao M: Explaining medically unexplained symptoms. Can J Psychiatr. 2004, 49 (663): 672-
10.
O'Reilly D, Steele K, Merriman B, Gilliland A, Brown S: Patient removals from general practitioners lists in Northern Ireland: 1987-1996. Br J Gen Pract. 1998, 48: 1669-1673.PubMedPubMedCentral
11.
O'Reilly D, Steele K, Merriman B, Gilliland A, Brown S: Effect of fundholding on removing patients from general practitioners' lists: Retrospective study. Br Med J. 1998, 317: 785-786. 10.1136/bmj.317.7161.785.CrossRef
12.
O'Reilly D, Gilliland A, Steele K, Kelly C: Reasons for patient removals: Results of a survey of 1005 GPs in Northern Ireland. Br J Gen Pract. 2001, 51 (469): 661-663.PubMedPubMedCentral
13.
O'Reilly D, Steele K: The removal of patients who live outside the practice boundary. Br J Gen Pract. 2005, 55: 384-386.PubMedPubMedCentral
14.
Munro J, Skinner J: Unwelcome customers? The epidemiology of removal from general practitioners lists in Sheffield. Br J Gen Pract. 1998, 48: 1837-1839.PubMedPubMedCentral
15.
Pickin M, Sampson F, Munro J, Nicholl J: General practitioners' reasons for removing patients from their lists: postal survey in England and Wales. Br Med J. 2001, 322 (7295): 1158-1159. 10.1136/bmj.322.7295.1158.CrossRef
16.
Munro J, Sampson F, Pickin M, Nicholl J: Patient de-registration from GP lists: and patient and professional perspectives. Final report to the Department of Health. 2002, Sheffield, UK: University of Sheffield
17.
Sampson F, Munro J, Pickin M, Nicholl J: Why are patients removed from their doctors' lists? A comparison of patients' and doctors' accounts of removal. Fam Pract. 2004, 21 (5): 515-518. 10.1093/fampra/cmh507.CrossRefPubMed
18.
Stokes T, Dixon-Woods M, McKinley RK: Breaking up is never easy: GPs' accounts of removing patients from their lists. Fam Pract. 2003, 20 (6): 628-634. 10.1093/fampra/cmg602.CrossRefPubMed
19.
Stokes T, Dixon-Woods M, Windridge KC, McKinley RK: Patients' accounts of being removed from their general practitioner's list: qualitative study. Br Med J. 2003, 326 (7402): 1316-10.1136/bmj.326.7402.1316.CrossRef
20.
Stokes T, Dixon-Woods M, McKinley RK: Ending the doctor-patient relationship in general practice: a proposed model. Fam Pract. 2004, 21 (5): 507-514. 10.1093/fampra/cmh506.CrossRefPubMed
21.
Stokes T, Dixon-Woods M, Williams S: Breaking the ceremonial order: patients' and doctors' accounts of removal from a general practitioner's list. Sociology of Health and Illness. 2006, 28 (5): 611-636. 10.1111/j.1467-9566.2006.00509.x.CrossRefPubMed
22.
Shaw I: Doctors, 'Dirty work' patients and revolving doors. Qualitative Health Care Res. 2004, 14 (8): 1032-1045. 10.1177/1049732304265928.CrossRef
23.
24.
Charmaz K: Constructing Grounded Theory. A practical guide through qualitative analysis. 2006, London: Sage Publications Ltd
25.
Greene J, Hall JN: Dialectics and pragmatism. AGE Handbook of Mixed Methods in Social and Behavioural Research. Edited by: Tashakkori A, Teddlie C. 2010, Thousand Oaks: SAGE, 119-143. 2CrossRef
26.
Onwuegbuzie AJ, Combs JP: Emergent data analysis techniques in mixed methods research. SAGE Handbook of Mixed Methods in Social and Behavioural Research. Edited by: Tashakkori A, Teddlie C. 2010, Thousand Oaks: SAGE, 397-430. 2CrossRef
27.
May D, Kelly MP: Chancers, pests and poor wee souls: problems of legitimation in psychiatric nursing. Sociology of Health and Illness. 1982, 4 (3): 279-301. 10.1111/1467-9566.ep10487972.CrossRefPubMed
28.
Kelly MP, May D: Good and bad patients: a review of the literature and a theoretical critique. J Adv Nurs. 1982, 7: 147-156. 10.1111/j.1365-2648.1982.tb00222.x.CrossRefPubMed
29.
Emerson RM, Pollner M: Dirty work designations: their features and consequences in a psychiatric setting. Soc Probl. 1976, 23: 243-254. 10.2307/799771.CrossRef
30.
Strong PM: Doctors and dirty work-the case of alcoholism. Sociology of Health and Illness. 1980, 2 (1): 24-47. 10.1111/1467-9566.ep11340296.CrossRefPubMed
31.
Mechanic D: Practice orientations among general medical practitioners in England and Wales. Med Care. 1970, 8 (1): 15-25. 10.1097/00005650-197001000-00003.CrossRefPubMed
32.
Loxterkamp D: Why rivers run: on the headwaters of family medicine. Br Med J. 2008, 337: a2575-10.1136/bmj.a2575.CrossRef
33.
34.
Eysenck MW: Fundamentals of Cognition. 2006, East Sussex, UK, USA and Canada: Psychology Press, 1
35.
Moorey J, Davidson K, Evans M, Feigenbaum J: Psychological theories regarding the development of personality disorder. Personality Disorder and Community Mental Health Teams: a practitioners guide. edn. Edited by: Sampson MJ, McCubbin RA, Tyrer P. 2006, England: John Wiley and sons, 59-89.CrossRef
36.
Nishida H: Cultural Schema Theory. Theorizing about intercultural communication. Edited by: Gudykunst WB. 2005, Thousand Oaks, California: Sage Publications, Inc, 401-418. 1
37.
Blackburn D: What is Personality Disorder?. Personality Disorder and Community Mental Health Teams: a practitioners guide. edn. Edited by: Sampson MJ, McCubbin RA, Tyrer P. 2006, England: John Wiley and sons, 21-39.CrossRef
Metadata
Title
Understanding “revolving door” patients in general practice: a qualitative study
Authors
Andrea E Williamson
Kenneth Mullen
Philip Wilson
Publication date
01-12-2014
Publisher
BioMed Central
Published in
BMC Primary Care / Issue 1/2014
Electronic ISSN: 2731-4553
DOI
https://doi.org/10.1186/1471-2296-15-33

Other articles of this Issue 1/2014

BMC Primary Care 1/2014 Go to the issue

Research article

Depression diagnosis and treatment amongst multimorbid patients: a thematic analysis

Research article

A Lacanian view on Balint group meetings: a qualitative analysis of two case presentations

Research article

Patient presentation and physician management of upper respiratory tract infections: a retrospective review of over 5 million primary clinic consultations in Hong Kong

Study protocol

Study protocol of EMPOWER Participatory Action Research (EMPOWER-PAR): a pragmatic cluster randomised controlled trial of multifaceted chronic disease management strategies to improve diabetes and hypertension outcomes in primary care

Research article

Repeated primary care consultations for non-specific physical symptoms in children in UK: a cohort study

Research article

The effect and acceptability of tympanometry and pneumatic otoscopy in general practitioner diagnosis and management of childhood ear disease