Researchers interviewed 28 patients who had been removed from their general practitioner's list. The interviews were often very emotionally charged, with patients expressing a range of emotions, including grief, anger, hatred, alienation, and depression.
Patients viewed their removal as unjustified and showed that they were "good" patients, who attempted to comply with the rules they understood to govern the doctor-patient relationship.
Patients viewed the removing general practitioner as someone who broke the "lay rules" of the doctor-patient relationship: that doctors should be caring, polite, truthful, and clinically competent and should value personal care. According to the patients, "bad" GPs broke the "caring" rule by "not being bothered," not listening to patients, or not acknowledging their concerns.
Patients experienced removal as deeply distressing and stigmatising. Some saw their removal as an abuse of power by GPs, especially as GPs were not required to justify their actions.
This study shows the negative impact of decisions about removal on patients, say the authors. They suggest measures that could help to mitigate some of these effects, such as a clear practice policy on removal that is accessible to patients and informing patients of the reasons for their removal.
However, the circumstances that lead to removal are not straightforward, and the views and priorities of both parties – patients and GPs – must be considered in any moves to reform this area, they conclude.
Rafat Saeed lives in West London and has had difficulties finding a local GP willing to take him on. Commenting on the research he says: "Being removed without knowing why is very distressing and most upsetting. There should not be any discrimination once a patient is reallocated, but due to a lack of communication and help, discrimination takes place. Patients have to carry the burden of being tagged."