The Conference for General Practice 2009
Objectives The medical literature suggests that older patients may be reluctant to engage general practice registrars in their medical care. This can lead to distortions in the clinical caseload of general practice registrars and dissatisfaction for older patients when seeing general practice registrars. The authors undertook a qualitative study of older patients to investigate their attitudes to having general practice registrars involved in their medical care to address this issue. Methods The study was conducted in three general practice (GP) training practices in southeast NSW, Australia. Appropriate ethics approval was obtained before commencing the research. Reception staff handed patients invitations after the patients’ consultations with either a general practice registrars or one of the established GPs. Thirty-eight patients aged 60 years and over agreed to participate in a semi-structured telephone interview exploring the patients’ responses to the general practice registrars and their opinions on their medical care in general. The interviews were recorded, transcribed verbatim and analysed using a template analysis approach. Results Analysis of the relationships between older patients, their regular doctors and general practice registrars produced five major themes of patient attitude: ‘desire for continuity’, ‘desire for access’, ‘openness’, ‘trust’ and a desire for ‘meaningful communication’. For most patients their interaction with the general practice registrar was viewed in the context of their relationship with their usual GP. Discussion Older patients’ attitudes to general practice registrars cannot be viewed in isolation from their relationships with their regular general practitioners. Older patients invest significant meaning in these long-term doctor-patient relationships. This needs to be taken into account when engaging general practice registrars in the care of older patients. Implications for practice Older patients’ acceptance of general practice registrars may be improved by developing systems to ensure that patients maintain relational and informational continuity with their usual GP. Models of teaching where continuity of care is shared between the GP and general practice registrar may also assist. Further research is required.