What general practitioners find satisfying in their work: Implications for health care system reform

PURPOSE We sought to explore general practitioners' satisfaction with their patient visits and the congruity between this satisfaction and new models of practice, such as those implicit in the new general medical services contract in the United Kingdom. METHODS We undertook a qualitative study using audio recordings of patient visits and in-depth interviews with 19 general practitioners in Lothian, Scotland. RESULTS Doctors' reports of satisfying and unsatisfying experiences during consultations were primarily concerned with developing and maintaining relationships rather than with the technical aspects of diagnosis and treatment. In their most satisfying consultations, they used the interpersonal aspects of care, in particular their sense of knowing the patient, to effect a successful outcome. Success was seen in holistic terms-not as the prevention, treatment, or cure of a disease, but as restorative of the person. Positive experiences were implicated in maintaining their identity as "good" doctors. Negative experiences sometimes challenged this identity, and doctors resisted this challenge by finding explanations for unsatisfactory experiences that distanced themselves from their source or cause. CONCLUSION The attributes of a satisfying encounter found in this study derive from a model of practice that prioritizes the distress of patients, which cannot be measured, above the technical and quantifiable in diagnosis and treatment. Preoccupation with that which is technical and measurable in health care system reforms risks defining a model of practice with purpose and meaning not congruent with doctors' experiences of their work and may result in further destruction of professional morale.