Patient identified factors contributing to patient safety incidents in primary care
| Patient identified factor contributing to safety incidents | Potential outcome (type of harm) | Illustrative verbatim quote |
|---|---|---|
| Communication | Delay in diagnosis and treatment Psychological harm (upset, belittled) Physical harm (pain and suffering) | I found that after 10 years with the same GP that I was being yelled at […] I […] don't need that […] and it was because doctors didn't listen to me recently that I … had to have eleven hours of surgery and I kept saying, and they said ‘nah it's all in your head’ … so the specialists in Melbourne in the end said I suffered a lot longer than I needed to because GPs didn't listen. (37 year old woman with a congenital chronic condition) |
| Access | Delay in treatment Physical harm (pain and suffering) Psychological harm (stress and anxiety) | It's all very well to say you can see your doctor when you want to; you can't. My wife has dementia which is exacerbated by urinary tract infections. It gets exacerbated dramatically and … traumatically … I couldn't see a doctor to get antibiotics for her for three days […] So to not have a doctor available for three days […] [in case of emergency or urgent care] is ridiculous. (69-year-old man carer with multiple chronic conditions) |
| Patient factors | Inadequate time with GP Delay in diagnosis and treatment Psychological harm (fear, vulnerability) | You know, I can go in there and say … ‘look how much time have you got?’, ‘well 5 minutes’, I say ‘well I can't do it in 5 minutes so we're wasting each other's time, so don't charge me’, and walk out again. I can do that. Other people can't. Other people are so dependent […] they're frightened. People are frightened to think that if they do speak up their treatment is going to be substandard. It's a real fear and that's why we don't get the complaints too … because if I complain then next time I need to use the service something bad's going to happen to me […] (55 year old woman carer and consumer representative) |
| External policy context | Delay in diagnosis and treatment Psychological harm (stress, anxiety) | Conversation between participants: Facilitator: Do you think not bulk billing is a big barrier [to accessing care]? P1: Yes because they don't tell you beforehand that they want the money upfront … (76 year old woman with multiple chronic conditions) P2: It's like having Al Capone with the cannon in the hand; money or your life? (70 year old man with multiple chronic conditions) P1: Yeah, no that's shocking. P3: What happens if you can't afford that? (70 year old woman with multiple chronic conditions) P2: Well they won't see you. P4: You die. (74 year old man with multiple chronic conditions) |
| Dignity and respect | Psychological harm (upset, belittled) Delay in diagnosis and treatment | My son […] is brain damaged […] So I went up and fixed [the bill] up and there was a balance owing, and it was $40 and I said ‘no you must go back to your doctor’. I'm battling to get him to keep going back to the doctor and so he's going to his usual GP who bulk bills him [no payment required], and when he went there to say … ‘I've come to see my doctor’, they said ‘would you go to the accounts department’. And then he got dressed down by a girl who would have been 18 at the least and he's 43 years of age, and he was so confused, humiliated, he didn't know what to do. So he came home to me and said ‘I couldn't go to the doctor’. (71 year old woman carer with multiple chronic conditions) |
| Primary–secondary interface | Physical harm (pain and suffering) Psychological harm (stress, anxiety, depression) | He went through this [acquired brain injury] and he left hospital and of course he didn't know what he was doing so he went to the doctor […] and said I'm not allowed to go back to work until you give me the all clear and he said ‘oh well what's, what's been wrong?’ He said ‘I've had a hypo’ […] so he tested his blood pressure, tested his sugar and said ‘yes, you can go back to work’. He went back to work and […] He didn't have a clue what he was doing […] and the rest of the men decided they'd bully him because he couldn't remember what to do and how to do it. So they bullied him to the extent that he tried to commit suicide coming home from work. So then I stepped in and went to the doctors […] I told him [what happened] and so he looked it up on the [computer] and he said ‘there's nothing here’. Now the hospital do not send their records to the doctors clinic; to your GP. They keep them at the hospital. (71 year old woman carer with multiple chronic conditions) |
| Continuity of care | Psychological harm (relationship effects—loss of trust) | … you get attached to your GP, it's a personal thing, he … knows more about you, than next to your wife or your partner … what's wrong with you, how you're reacting to certain things […] you form a … bond, a friendship,? And to break away from that all of a sudden […] and to be treated so off-headedly and saying well you know I couldn't care less really … what you do? […] it breaks you up and then you gotta start all over, and that's the hard part you gotta start all over again; now can I trust this bloke? (73-year-old man with multiple chronic conditions) |
| Task performance (skill, competence) | Delay in diagnosis and treatment Failure to appreciate severity/acuity of problem Psychological harm (loss of trust and confidence) | Conversation between two participants: P1: I went [to the GP clinic] I'm a diabetic, and I had […] a racing heart … which was in de fib and it was … running at 145 beats a minute. And they weren't concerned; they were more worried about why I didn't take a certain tablet. They focused on that rather than trying to help me find the problem so I just walked away. (63 year old man with multiple chronic conditions) P2: It makes you feel like why do you want to go to your local GP because you're not getting the support and help you need. (59 year old woman carer) |
| Task characteristics—care coordination and information management | Delay in diagnosis and treatment Physical harm (pain and suffering) | I've got a friend who […] can't really walk cos he's in a wheelchair most of the time and in a lot of pain, and he travels backwards and forwards to [metropolitan suburb] for pain management and they keep telling him that they don't know what's causing it and he has to carry the letters back to his GP, they don't … talk to his GP …] they don't even talk to the Professor and the pain management doctor. They don't even talk to each other. And they're looking for [someone] who can coordinate the information between the five or six people that he is dealing with … so he can get an answer and get relief from the pain. (70-year-old man with multiple chronic conditions) |
| Task characteristics—prescribing | Unnecessary medication/treatment Physical harm (medication side effects) | … the doctor didn't find anything wrong … but gave me antibiotics anyway without really telling ‘yes, I'm quite sure this is viral and it needs antibiotics’, it was just like ‘oh no the antibiotics will clear it up’ […] I've heard that they can do that just to sort of reassure the mother that ‘[…] at least something's being done’ cos with a viral thing you just normally […] let it run its course … because [my child] ended up vomiting a bit of blood and so I was also doubly concerned about that. I took him to emergency and they said ‘[…] it's probably the antibiotics just irritating … his system because he doesn't even really need them’. (30 year old mother) |
| Task characteristics—decision making | Unnecessary treatment Psychological harm (stress, anxiety, discomfort) | […] the doctors say ‘I want you to do this’, and you don't really want to do it, you can say why you don't feel comfortable about doing it and then you maybe work around it. But at the moment there's no such thing because you're told to do things […] I wasn't asked ‘did I want that tablet?’ I was told it was going to be prescribed. (60 year old woman with multiple chronic conditions) |
| Time in the consultation | Delay in diagnosis and treatment Unnecessary repeat visits Psychological harm (stress, anxiety, frustration) | I sometimes have a few matters to discuss but … my time is spot on the 20 minutes. When that magic time that my appointment is [over] I'm out the door, without so much as by your leave … I have […] on occasion had serious matters I wanted to discuss with him but haven't had the opportunity so then … I have to go […] make another appointment, try to discuss it with him and find myself out the door again […] it's … very very unsatisfactory … (69-year-old man with multiple chronic conditions and a carer) |
| Safety culture | Physical harm (pain and suffering) Psychological harm (loss of trust) | I think some doctors are careful too cos when I had [my child][…] my doctor was looking after me and then I got handed over to another higher up the ranks and my doctor got shoved aside. And I think they're too intimidated by the other doctors to actually say this should happen … when I went back to my doctor he didn't actually say anything negative about [the harm], but obviously things went wrong […] I think they're just too scared to, like the pecking order of the doctors … (28 year old mother) |
| Team factors | N/A | … how I see it working in a team is for you and your doctor to understand each other. He can talk to me the way he wishes … to explain my problem and I can respond back to him exactly the same way. And then he can refer me to who he thinks is going to be right. And then those two confer with each other about my problem. And also that specialist is given the freedom by my GP to be able to talk to me the same way. So in other words forming a teamwork where I … consider my GP to be in charge, he's in number one, and then he's got these specialists that he's referred me to; reporting back to him; and then he in turn lets me know what's going on […] (73-year-old man with multiple chronic conditions) |
| Physical environment | Infection | Conversation between two participants: P1: […] you go there and you wait and sit in there for an hour or so with all these people coughing and sneezing everywhere … (73 year old man with multiple chronic conditions) P2: But you can't do anything about it […] maybe the government should be looking at […] the doctors waiting rooms and the facilities in there for looking after patients. People with flu should maybe be made to wear masks, have masks in the waiting room for people to put on […] (73 year old man with multiple chronic conditions) |
N/A, not applicable.