Discipline of Medical Imaging Science, Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia.
Biomedical Informatics and Digital Health, Charles Perkins Centre D17, Faculty of Medicine and Health, Sydney, New South Wales, Australia.
Health Expect. 2023 Dec;26(6):2453-2460. doi: 10.1111/hex.13849. Epub 2023 Aug 16.
With the increasing availability of information, patients are becoming more informed about radiology procedures and requesting imaging studies. This qualitative study aims to explore factors that influence general practitioners' (GPs) decisions to fulfil patient requests for imaging studies during clinical consultation.
Semi-structured interviews were conducted with 10 GPs working across five private medical centres in Northwest Sydney. Conventional content analysis was used with emergent themes to identify GPs perspectives.
Six themes stood out from the interviews with GPs fulfilling patient requests for imaging studies. They included four pertaining to patient factors: patient expectations, 'therapeutic scans', 'impressive labels' and entitled. Two further themes pertained to the GP perspective and included defensive medicine, and 'new patients'. Requests are fulfilled from anxious or health-obsessed patients, with GPs worrying about litigation if they refuse. However, GPs decline requests from patients with entitlement attitudes or during first visits.
The findings suggest that GPs struggle to balance their responsibilities as gatekeepers of imaging with patients' expectations of request fulfilment. Clear guidelines on the appropriate use of diagnostic imaging and its limitations could help patients understand its proper use and ease anxiety. Additionally, education and training for GPs could help them manage patient expectations and provide appropriate care.
Patients, service users, caregivers, people with lived experiences or members of the public were not directly involved in the design, conduct, analysis or interpretation of the study. However, our study was conducted in primary care facilities where the GPs were interviewed about patients' requests for diagnostic imaging based on their own initiatives. GPs' perspectives in managing patient expectations and healthcare utilisation were explored within the Australian Medicare system, where medical imaging and image-guided procedures come at little to no cost to the individual. The study findings contribute to a better understanding of the challenges faced by GPs in dealing with patient consumerism and requests for diagnostic imaging, as well as factors influencing request fulfilment or denial. Insights gained from this study may inform future research about delivering patient-centred care within a similar context.
随着信息的日益普及，患者对放射学程序有了更多的了解，并要求进行影像学检查。本定性研究旨在探讨影响全科医生在临床咨询中满足患者影像学检查请求的因素。
对在悉尼西北部五家私人医疗中心工作的 10 名全科医生进行半结构化访谈。采用新兴主题的常规内容分析，以确定全科医生的观点。
从满足患者影像学检查请求的全科医生访谈中得出了 6 个主题。其中包括与患者相关的 4 个因素：患者期望、“治疗性扫描”、“令人印象深刻的标签”和“有权要求”。另外两个主题与全科医生的观点有关，包括防御性医疗和“新患者”。有焦虑或过度关注健康的患者会提出请求，全科医生担心拒绝会引发诉讼。然而，对于有权利要求态度或在首次就诊时的患者，全科医生会拒绝他们的请求。
研究结果表明，全科医生在平衡作为影像学检查把关者的责任与患者对请求满足的期望方面存在困难。关于诊断影像学的适当使用及其局限性的明确指南可以帮助患者了解其正确使用方法并减轻焦虑。此外，对全科医生进行教育和培训可以帮助他们管理患者的期望并提供适当的护理。
患者、服务使用者、护理人员、有生活经验的人或公众没有直接参与研究的设计、进行、分析或解释。然而，我们的研究是在初级保健设施中进行的，在这些设施中，全科医生根据自己的倡议，就患者对诊断影像学的请求接受了采访。本研究探讨了在澳大利亚医疗保险制度下，全科医生在管理患者期望和医疗保健利用方面的观点，在该制度下，个人无需支付医疗成像和图像引导程序的费用。研究结果有助于更好地了解全科医生在应对患者消费主义和诊断影像学请求方面所面临的挑战，以及影响请求满足或拒绝的因素。从这项研究中获得的见解可能为在类似背景下提供以患者为中心的护理的未来研究提供信息。
