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Research

Patients' accounts of being removed from their general practitioner's list: qualitative study

BMJ 2003; 326 doi: https://doi.org/10.1136/bmj.326.7402.1316 (Published 12 June 2003) Cite this as: BMJ 2003;326:1316

This article has a correction. Please see:

  1. Tim Stokes (tns2{at}le.ac.uk), senior lecturer in general practice1,
  2. Mary Dixon-Woods, senior lecturer in social science and health2,
  3. Kate C Windridge, research fellow1,
  4. Robert K McKinley, senior lecturer in general practice1
  1. 1 Department of General Practice and Primary Health Care, University of Leicester, Leicester General Hospital, Leicester LE5 4PW
  2. 2 Department of Epidemiology and Public Health, University of Leicester, Leicester LE1 6TP
  1. Correspondence to: T Stokes
  • Accepted 1 May 2003

Abstract

Objective To explore patients' accounts of being removed from a general practitioner's list.

Design Qualitative analysis of semistructured interviews.

Setting Patients' homes in Leicestershire.

Participants 28 patients who had recently been removed from a general practitioner's list.

Results The removed patients gave an account of themselves as having genuine illnesses needing medical care. In putting their case that their removal was unjustified, patients were concerned to show that they were “good” patients who complied with the rules that they understood to govern the doctor-patient relationship: they tried to cope with their illness and follow medical advice, used general practice services “appropriately,” were uncomplaining, and were polite with doctors. Removed patients also used their accounts to characterise the removing general practitioner as one who broke the lay rules of the doctor-patient relationship. These “bad” general practitioners were rude, impersonal, uncaring, and clinically incompetent and lied to patients. Patients felt very threatened by being removed from their general practitioner's list; they experienced removal as an attack on their right to be an NHS patient, as deeply distressing, and as stigmatising.

Conclusions Removal is an overwhelmingly negative and distressing experience for patients. Many of the problems encountered by removed patients may be remediable through general practices having an explicit policy on removal and procedures in place to help with “difficult” patients.

Footnotes

  • We thank all the patients in Leicestershire who took part in the study and Colette Braidwood and colleagues at Leicestershire Health Authority for organising the recruitment of patients into the study.

  • Contributors: TS was the principal investigator and was involved in designing the study, gathering and analysing data, and writing the paper. MD-W and RKMcK were involved in designing the study, supervising the analysis, and writing the paper. KCW carried out the interviews and maintained a reflexive diary. All authors contributed to the final version of the paper. TS will act as guarantor for the paper.

  • Funding Scientific foundation board of the Royal College of General Practitioners.

  • Competing interests None declared.

  • Ethical approval: Leicestershire research ethics committee approved the study.

  • Accepted 1 May 2003
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