On multiple problems: the ethics of multiple problems in single general practitioner appointments.

Abstract

Bringing multiple problems to a single general practitioner (GP) appointment raises various ethical issues, all of which emerge from the central tension between the total number of problems brought to the appointment and the finite amount of time allocated to undertake it. This paper finds that it would be unreasonable to only consider autonomy as being respected if all problems are addressed in a single appointment; the GP is required to address those problems that would maximally promote beneficence within the constraints of the single appointment; dealing with multiple problems in single appointments might violate non-maleficence by reducing the time dedicated to each problem and fostering error-producing conditions and is likely to reduce patient satisfaction, while any GP lateness generated by dealing with multiple problems in single appointments has negative impacts on subsequent patients; justice requires an equity, rather than a strict equality, approach to GP appointment allocation, and therefore requires the booking of additional appointments to safely and effectively deal with a patient's multiple problems when relevant factors, such as complexity, are present and addressing multiple problems in single GP appointments exacerbates the burnout-producing conditions faced by GPs, which both negatively impacts GPs and patient safety and contributes to GPs leaving the workforce, which reduces the availability of GP appointments and thus violates beneficence. This paper makes three suggestions for practice, recognises various challenges to these recommendations and suggests how they should be addressed.