Topic 3: Challenges and measures
Time constraints were mentioned as a major challenge to the establishment of long-term, secure doctor-patient relationships. For example, one of the doctors had 20 consultations per day on average, with a time limit of 10–20 minutes with each patient per consultation, paperwork included.
'Again I believe that for a person to communicate such a sensitive matter as this, it requires a totally different setting from what we have on a daily basis, in well-defined consultations in general practice. I believe that we cannot avoid seeing that sometimes, we actually need to attend to this particular patient for a little longer.'
One of the doctors specified that time constraints could be solved by having more permanently salaried GPs with greater capacity and fewer patients on their lists. Others referred to the need for better basic competence in eating disorders.
'I studied medicine in the 70s, and I cannot recall hearing anything about eating disorders. When you haven't learned anything about it in medical school, nor come across it on the foundation course or later – it's not a matter that's especially close to your heart. Perhaps you feel that this is not your special talent and you therefore have little to contribute, then it's OK that someone else takes care of it. In general practice, you need to know something about most things. You cannot know everything about everything, so some things must be excluded.'
It was noted that a lack of basic competence could be compensated for by further education and training, but that eating disorders were perhaps not something to be prioritised in a cost-benefit perspective. On the other hand, many of the doctors called for a simple screening tool: 'Perhaps some tools that don't necessarily have to be applied in a fully standardised way, but at least could help raise awareness of this patient group among us doctors.'
The doctors also mentioned the limited opportunity to refer patients to the specialist health service because of the long waiting times and a strict selection of only the very sickest patients. One doctor wanted the specialist health service to exercise its duty to provide guidance more actively:
'I would like the specialist health service to live up to its duty to provide guidance to a greater extent. If they could teach us more about this kind of group that they are dealing with a lot, and we perhaps little, it would be a great help for us.'
Some called for better municipal services, where the doctor could collaborate with a nutritionist and a psychologist as well as with group-based programmes arranged by the Healthy Living Centres.