Quotes: patients’ motives for self-referral and GPs’ referral motives
| Patient‘s motive | GP‘s motive | |
| Attractiveness of emergency department care | ‘[…] because they think that they get everything quickly in the ED, which they do not have instant access to in the outpatient sector […].’ (GP 10) ‘Meaning, that they can go there anytime […].’ (GP 9) ‘They believe that the real specialists […] are in the hospital.’ (GP 12) ‘[…] because they do not have the time or might just not feel like sitting down in the GP’s waiting area.’ (GP 15) ‘[…] patients go to the ED because they don’t want to wait for an appointment.’ (GP 13) | ‘I refer to the ED only in situations that are no longer manageable in the outpatient sector.’ (GP 12) ‘If there is another acute exacerbation […] this patient belongs in the hospital, because the guidelines say so for such constellations […].’ (GP 8) ‘If I would have to wait 24 hours for my laboratory results […] and my differential diagnosis is potentially life-threatening, then I send to the ED.’ (GP 14) ‘If I really need either rapid tests or clinical parameters that I can’t ascertain here.’ (GP 8) |
| Patient-specific factors | ‘Usually they are suffering from acute symptoms […]. Such are situations that cannot be coped with at home […]. Then my patients go to the hospital […].’ (GP 5) ‘Then of course, because they experience something acute, which scares them.’ (GP 6) ‘[…] the age of the patient plays a role. Young people are much more hectic and much more afraid […].’ (GP 8) ‘I do believe that it plays a role […] in making the decision: ‘I won’t go to my GP, but straight to the ED’. Which of course signifies that the doctor-patient relationship and the bond of trust with the GP is not so good.’ (GP 11) ‘Suddenly they all come and have something. There was something on TV again […]. In my view, they scare patients there.’ (GP 4) | ‘And I always decide to refer to the ED when my gut tells me ‘attention, attention, this is dangerous, acutely dangerous’. […] – for me, the criterion is ‘acutely dangerous for the person affected.’ (GP 11) ’And this patient came to the practice with most severe dyspnea during the week, […]. I experienced him as […] severely ill.’ (GP 14) ‘It plays a role in the decision, how is the patient’s care situation at home? […] Is care ensured? And if it is not ensured, in case of an acute event, he has to be admitted to hospital.’ (GP 2) ‘Sometimes it is an issue, with very frail patients, who are not able to organize themselves, […] you know this will not work in the outpatient situation.’ (GP 7) |
| Organisational issues | ‘There are always times when I’m not here. It is Tuesday afternoon now, my practice closed at 2 pm today. Where do the patients go? They go to the ED.’ (GP 12) ‘[…] if it’s a strong cough […] I must be able to go to my doctor on the same day. And if I can’t, because I’m denied access, I’ll go to an ED.’ (GP 13) ‘There are people who may not even have a GP […]. It may seem the easiest option for them.’ (GP 13) | ‘[…] when there is no other option to get this resolved in the outpatient sector prior to the weekend.’ (GP 3) ‘I think we have a massive problem at the moment, the problem of ‘finding appointments with specialist’. Patients wait very long […]. This can result in me having to send them to hospital […].’ (GP 4) |
ED, emergency department; GP, general practitioner.