Making complex decisions in uncertain times: experiences of Dutch GPs as gatekeepers regarding hospital referrals during COVID-19—a qualitative study
Abstract Background General practitioners often act as gatekeeper, authorizing patients’ access to hospital care. This gatekeeping role became even more important during the current COVID-19 crisis as uncertainties regarding COVID-19 made estimating the desirability of hospital referrals (for outpat...
| Main Authors: | , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2021-11-01
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| Series: | BMC Medical Ethics |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s12910-021-00725-0 |
| _version_ | 1819202933813673984 |
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| author | Dieke Westerduin Janneke Dujardin Jaap Schuurmans Yvonne Engels Anne B. Wichmann |
| author_facet | Dieke Westerduin Janneke Dujardin Jaap Schuurmans Yvonne Engels Anne B. Wichmann |
| author_sort | Dieke Westerduin |
| collection | DOAJ |
| description | Abstract Background General practitioners often act as gatekeeper, authorizing patients’ access to hospital care. This gatekeeping role became even more important during the current COVID-19 crisis as uncertainties regarding COVID-19 made estimating the desirability of hospital referrals (for outpatient or inpatient hospitalization) complex, both for COVID and non-COVID suspected patients. This study explored Dutch general practitioners’ experiences and ethical dilemmas faced in decision making about hospital referrals in times of the COVID-19 pandemic. Methods Semi-structured interviews with Dutch general practitioners working in the Netherlands were conducted. Participants were recruited via purposive sampling. Thematic analysis was conducted using content coding. Results Fifteen interviews were conducted, identifying four themes: one overarching regarding (1) COVID-19 uncertainties, and three themes about experienced ethical dilemmas: (2) the patients’ self-determination vs. the general practitioners’ paternalism, (3) the general practitioners’ duty of care vs. the general practitioners’ autonomy rights, (4) the general practitioners’ duty of care vs. adequate care provision. Conclusions Lack of knowledge about COVID-19, risks to infect loved ones, scarcity of hospital beds and loneliness of patients during hospital admission were central in dilemmas experienced. When developing guidelines for future crises, this should be taken into account. |
| first_indexed | 2024-12-23T04:11:54Z |
| format | Article |
| id | doaj.art-d41eb584992b40749bcb602508ec4953 |
| institution | Directory Open Access Journal |
| issn | 1472-6939 |
| language | English |
| last_indexed | 2024-12-23T04:11:54Z |
| publishDate | 2021-11-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Medical Ethics |
| spelling | doaj.art-d41eb584992b40749bcb602508ec49532022-12-21T18:00:29ZengBMCBMC Medical Ethics1472-69392021-11-012211810.1186/s12910-021-00725-0Making complex decisions in uncertain times: experiences of Dutch GPs as gatekeepers regarding hospital referrals during COVID-19—a qualitative studyDieke Westerduin0Janneke Dujardin1Jaap Schuurmans2Yvonne Engels3Anne B. Wichmann4Department of Anesthesiology, Pain and Palliative Medicine, Radboud University Medical CenterDepartment of Anesthesiology, Pain and Palliative Medicine, Radboud University Medical CenterDepartment of Anesthesiology, Pain and Palliative Medicine, Radboud University Medical CenterDepartment of Anesthesiology, Pain and Palliative Medicine, Radboud University Medical CenterDepartment of Anesthesiology, Pain and Palliative Medicine, Radboud University Medical CenterAbstract Background General practitioners often act as gatekeeper, authorizing patients’ access to hospital care. This gatekeeping role became even more important during the current COVID-19 crisis as uncertainties regarding COVID-19 made estimating the desirability of hospital referrals (for outpatient or inpatient hospitalization) complex, both for COVID and non-COVID suspected patients. This study explored Dutch general practitioners’ experiences and ethical dilemmas faced in decision making about hospital referrals in times of the COVID-19 pandemic. Methods Semi-structured interviews with Dutch general practitioners working in the Netherlands were conducted. Participants were recruited via purposive sampling. Thematic analysis was conducted using content coding. Results Fifteen interviews were conducted, identifying four themes: one overarching regarding (1) COVID-19 uncertainties, and three themes about experienced ethical dilemmas: (2) the patients’ self-determination vs. the general practitioners’ paternalism, (3) the general practitioners’ duty of care vs. the general practitioners’ autonomy rights, (4) the general practitioners’ duty of care vs. adequate care provision. Conclusions Lack of knowledge about COVID-19, risks to infect loved ones, scarcity of hospital beds and loneliness of patients during hospital admission were central in dilemmas experienced. When developing guidelines for future crises, this should be taken into account.https://doi.org/10.1186/s12910-021-00725-0Qualitative researchEthical issuesSars coronavirusGeneral practitionersHospital referralShared decision making |
| spellingShingle | Dieke Westerduin Janneke Dujardin Jaap Schuurmans Yvonne Engels Anne B. Wichmann Making complex decisions in uncertain times: experiences of Dutch GPs as gatekeepers regarding hospital referrals during COVID-19—a qualitative study BMC Medical Ethics Qualitative research Ethical issues Sars coronavirus General practitioners Hospital referral Shared decision making |
| title | Making complex decisions in uncertain times: experiences of Dutch GPs as gatekeepers regarding hospital referrals during COVID-19—a qualitative study |
| title_full | Making complex decisions in uncertain times: experiences of Dutch GPs as gatekeepers regarding hospital referrals during COVID-19—a qualitative study |
| title_fullStr | Making complex decisions in uncertain times: experiences of Dutch GPs as gatekeepers regarding hospital referrals during COVID-19—a qualitative study |
| title_full_unstemmed | Making complex decisions in uncertain times: experiences of Dutch GPs as gatekeepers regarding hospital referrals during COVID-19—a qualitative study |
| title_short | Making complex decisions in uncertain times: experiences of Dutch GPs as gatekeepers regarding hospital referrals during COVID-19—a qualitative study |
| title_sort | making complex decisions in uncertain times experiences of dutch gps as gatekeepers regarding hospital referrals during covid 19 a qualitative study |
| topic | Qualitative research Ethical issues Sars coronavirus General practitioners Hospital referral Shared decision making |
| url | https://doi.org/10.1186/s12910-021-00725-0 |
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