Understanding the work of general practitioners: a social science perspective on the context of medical decision making in primary care

BACKGROUND: The work of general practitioners (GPs) is increasingly being looked at from the perspective of the strategies and factors shaping it. This reflects the importance given to primary care services in health care system reform. However, the literature provides little insight into the medical decision-making processes in general practice. Our main objective was to better understand how organizational and environmental factors influence the work of GPs. METHODS: We interviewed 28 GPs working in contrasting organizational settings and environments. The data analysis involved using structuration theory to enrich the interpretation of empirical material. RESULTS: We identified four main factors that influence the practice of GPs: mode of remuneration, peer-to-peer interactions, patients' demands and the availability of other medical resources in the environment. These four conditions of action – what we call primary effects – can directly influence the performance of medical acts and time management, as well as the degree of specialization of GPs. Decisions related to each of those aspects can have a variety of both intentional and non-intentional consequences – what we call secondary effects – that are then likely to become conditions for subsequent action. CONCLUSION: This qualitative study helps shed light on the complex causal loops of interrelated factors that shape the work of GPs.