[General practitioners' representations and perceptions about the medical practice standards they are facing]

Abstract

Background: Since the early 1990s, national health institutions including the national health insurance increase the incentives for physicians to comply with standards of good practice dedicating these standards in medical practices. The objective of this study was to explore GP's on standards of medical practice in a context of standardization.

Method: Individual semi-structured qualitative interviews with 16 GPs in Île-de-France.

Results: Thematic analysis of 16 interviews has highlighted that doctors had the impression of being confronted with multiple medical practice guidelines from various sources. They said they consider these standards as indicative benchmarks and not as imperatives to comply. Strict standardization of practices did not seem compatible with their profession given the singular and complex nature of each situation and the necessary comprehensive care to their patients. They opposed ethical arguments insistent standardization. Mandatory standards appeared detrimental to their quality of care. Doctors have said it better accept scientific guidelines than standards of health insurance that seemed directed to them by economic considerations. They said also to experience a significant normative pressure from health insurance.

Discussion: GPs had spotted increasing standards governing their practices. They were not opposed to the fact that they may be indicative targets provided they are not mandatory.