Breaking the chains in plato's cave: acute care in general practice

BACKGROUND: It is known that Emergency Departments (EDs) handle lower patient loads during periods when general practitioners (GPs) are on service. However, the acute cases managed by GPs are not well described yet.

OBJECTIVE: This study aims to assess acute medical cases presented at GP's offices.

METHODS: Medical students documented urgent medical cases as defined by patients during a practice internship in GP practices in Northern Germany, from February to July 2024. Levels of urgency were defined as "not-acute" (could have been treated on another day), "acute" (had to be treated the same day) and "emergency" (had to be treated immediately). Additionally, patient's concerns and expectations were written down and analyzed using qualitative content analyses.

RESULTS: A total of 523 cases were collected from 53 practices. The majority of cases (82%) were treated solely within the practice. Regarding levels of urgency, 275 (53%) were graded acute, 170 (33%) were not-acute and 70 (13%) cases were graded emergencies. Patients' motivations for urgently visiting their GP are rooted in fears, motivated by relatives, psychological issues and pain. Expectations range from reassurance to diagnostic examinations to the issuing of a sick leave.

DISCUSSION: GPs play a critical role in managing acute medical cases. The holistic approach of GPs including strategies to cope with uncertainty might be useful to be expanded to more specialties of medicine in the acute care sector.

CONCLUSION: Motivations and expectations of a visit to a GP practice were diverse but comprehensible. An additional way to address the fears and uncertainties that send patients to the doctor could be through telemedicine offerings and educational initiatives, potentially starting as early as school age.