The most common reasons are that either the patient has moved, or the doctor has retired or is perceived to be too far away. There are additional reasons:
| Patient needs: | |
|---|---|
| One doctor for all the family | 5% |
| Wants woman doctor | 4% |
| Wants alternative medicine | 2% |
| Obstetric needs | 1% |
| Organizational problems: | |
|---|---|
| Long waits | 13% |
| No continuity of care | 6% |
| Rude receptionist | 6% |
| Wants appointments | 1% |
| Wants open surgeries | 1% |
| Other staff rude | 1% |
| Problems with doctor: | |
|---|---|
| Lost confidence in | 21% |
| Uninterested/rude | 20% |
| Prescriptions criticized | 5% |
| Doctor too hurried | 4% |
| Visits problematic | 4% |
| Communication poor | 4% |
A USA study found that a participatory decision-making style leads to patient satisfaction. Participation was found to depend, in part, on the degree of autonomy perceived to be enjoyed by the GP, and on the volume of work.
Another approach to gaining satisfaction is to agree and publish standards of care patients can expect, with performance figures for how nearly these standards are met in practice. This is the philosophy behind the UK government-led Patient's Charter/British Standards kitemark BS5750, which aims to:
- Set standards, eg by agreement with patient participation groups.
- Monitor progress towards these standards, and publish progress locally.
- Provide information about how services are organized. Maximize choice.
- Let users know who is in charge of what, and what their roles are.
- Explain to users what is done when things go wrong, and how services are improved, and what the complaints procedure is.
- Show that taxpayers money is being used efficiently.
- Demonstrate customer satisfaction.
This culture has proved alien to most GPs, perhaps owing to a very necessary preoccupation with illness and its curing, rather than service, and its glorification.
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