The evolution of the doctor-patient relationship after the introduction of a medical assistant in a person centred-care: a qualitative study from a patient perspective

Laura Blake, Irene Supper

Keywords: medical assistant; general practitioner; primary care; medical undeserved area; interprofessional collaboration; doctor-patient relationship; person-centred care

Background:

To deal with medical underserved areas, medical assistants (MA) have been recruited in France since 2018, relieving general practitioners (GP) from administrative tasks in order to guarantee a better access to primary care. The MA arrival fosters to reorganize the medical encounter, impacting the doctor-patient relationship.

Research questions:

In this study, we wanted to explain the evolution of the doctor-patient relationship after the introduction of a MA, according to a person-centred care model, from the patient's perspective.

Method:

This study followed a qualitative design based on individual semi-structured interviews. Patients were recruited until data saturation, on a purposive sampling base aiming for a maximum variation in participant age, gender, years of follow up. Double coding was performed after transcription and data anonymization. Thematic content analysis followed, with a principle of constant comparison according to Stewart’s 2024 person-centred care model.

Results:

19 interviews were conducted. The MA is seen by the patient as an intermediate facilitating the doctor-patient exchanges through organizational roles (waiting time, administrative tasks, emergency triage) and interpersonal skills, making the MA a pair and a figure of trust. However, the GP remains the expert of both intimacy and complexity and the privileged referent. The MA has no place in the shared decision-making. Task delegation and lack of information increase confusion in the patient navigation. By enhancing the time and emotional availability of the GP, the MA rehumanizes the doctor-patient relationship but has no impact on the outside system remaining pressurized by the doctor shortage.

Conclusions:

The MA is considered as a facilitating pair, enhancing the doctor-patient relationship. The GP remains the holistic medical care keeper in a fragmented system. More research is needed to find the right balance of interprofessional collaboration to avoid the loss of attractivity of the GP profession and the long-term economic viability for medical practices employing MAs.

Points for discussion:

The task delegation and the notion of “minor consultations”

The loss of attractivity of the GP profession: a European common point?

Is a European medical assistant possible? Needs for a clear legal framework, common tasks and a European pooling skills. Furthermore quantitative research is needed to identify the needs of practices experiencing different profiles of MAs.

#94