Patients changing their family doctor - the doctor's reaction

Objective: Patients who change their family doctor without changing their address call into question the adequacy of the service they have been receiving. In this study, patients were asked to state their reasons when requesting a change of doctor. The doctors were asked what they thought the reason was and how they felt about the patient's decision to leave their care. The new doctors chosen by the patients were also asked to describe their reactions to their new patients. Setting: A suburban health centre with seven doctors and 11,500 patients. Methods: Consecutive patients who requested a change of doctor over a six month period completed a written questionnaire. The questionnaires were presented for discussion at weekly practice meetings, the patient's stated reason for moving being revealed only after the doctors had expressed their opinions and feelings. Results: 61 individual and family requests were recorded, relating to 109 patients, comprising 0.9% of the practice population. 30% of requests were from patients who had been with their previous doctor for less then one year. Two-thirds of the patients had been thinking about changing doctors for several months. 23 (38% requests were for reasons related to practice organisation, and 33 (54% were for reasons related to clinical management issues. The doctor was aware of the patient's reason for requesting transfer in only 10 cases, and in 31 cases the doctor could not even identify the patient. The new doctors expressed negative feelings about accepting the seven patients whose reason for transferring was dissatisfaction with clinical care, whereas none of the 23 cases of transfer for practice-related reasons were unwelcome. Conclusions: Analysis of doctors' reactions to patient transfers suggests that transfer from one doctor to another cannot generally be interpreted as a catastrophic breakdown of the doctor-patient relationship. Either there was no significant bond to break, or the transfer was requested for reasons extraneous to this relationship, such as problems of access to the doctor.