Disruption to the doctor–patient relationship in primary care: a qualitative study

Abstract

Background: Starfield described the importance of system-level components of primary care (first contact, continuous, comprehensive, coordinated), on countries’ health systems. It is postulated that, at the individual level, interpersonal interactions and relationship-centred care are central to primary care. Aim: To explore the impact of COVID-19 on disruption to the doctor–patient relationship and subsequent development of new models of care. Design & setting: A series of 11 cross-sectional surveys of New Zealand (NZ) urban and rural primary care doctors, nurses, and managers, from May 2020 to February 2021, to understand and monitor responses to the pandemic. Method: Using inductive content analysis, cumulated qualitative data from doctors were examined through the lenses of the doctor–patient relationship, its disruption, and resulting changes in models of care. Results: There were 1519 responses to the surveys, representing 482 unique participants. The majority (86%) of responses were from doctors. The following four key themes emerged: moving to transactional consultations; task-shifting with team changes; creating a production line; and diminished communication and coordination across services. Conclusion: The advent of the pandemic led to severe and ongoing strain on practices requiring rapid change to the model of care. Team members took on new roles for triaging, testing, and separating patients with respiratory and non-respiratory symptoms. There was a rapid move to telehealth, with policies developed on where face-to-face consultations were necessary. Practice strain was exacerbated by disruption to coordination with secondary and other referral services. As new models of general practice develop, further disruptions to development of doctor–patient relationships must be avoided. This work extends Starfield’s system-level paradigm to the individual level, with the core value of primary care the doctor–patient relationship. Successful sustainable models are likely to be where relationships are treated as of central importance.