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...

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Autores principales:	Dieke Westerduin, Janneke Dujardin, Jaap Schuurmans, Yvonne Engels, Anne B. Wichmann
Formato:	article
Lenguaje:	EN
Publicado:	BMC 2021
Materias:	Qualitative research Ethical issues Sars coronavirus General practitioners Hospital referral Shared decision making Medical philosophy. Medical ethics R723-726
Acceso en línea:	https://doaj.org/article/d41eb584992b40749bcb602508ec4953
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spelling	oai:doaj.org-article:d41eb584992b40749bcb602508ec49532021-12-05T12:03:31ZMaking complex decisions in uncertain times: experiences of Dutch GPs as gatekeepers regarding hospital referrals during COVID-19—a qualitative study10.1186/s12910-021-00725-01472-6939https://doaj.org/article/d41eb584992b40749bcb602508ec49532021-11-01T00:00:00Zhttps://doi.org/10.1186/s12910-021-00725-0https://doaj.org/toc/1472-6939Abstract 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.Dieke WesterduinJanneke DujardinJaap SchuurmansYvonne EngelsAnne B. WichmannBMCarticleQualitative researchEthical issuesSars coronavirusGeneral practitionersHospital referralShared decision makingMedical philosophy. Medical ethicsR723-726ENBMC Medical Ethics, Vol 22, Iss 1, Pp 1-8 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Qualitative research Ethical issues Sars coronavirus General practitioners Hospital referral Shared decision making Medical philosophy. Medical ethics R723-726
spellingShingle	Qualitative research Ethical issues Sars coronavirus General practitioners Hospital referral Shared decision making Medical philosophy. Medical ethics R723-726 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
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.
format	article
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
title	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_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_sort	making complex decisions in uncertain times: experiences of dutch gps as gatekeepers regarding hospital referrals during covid-19—a qualitative study
publisher	BMC
publishDate	2021
url	https://doaj.org/article/d41eb584992b40749bcb602508ec4953
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Making complex decisions in uncertain times: experiences of Dutch GPs as gatekeepers regarding hospital referrals during COVID-19—a qualitative study

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