Thoughts on gatekeeping

The word ‘gatekeeping’ is often used to define part of the GP role but how do we see this?

It could be quite a negative part of our job, with the implication being it is about cost saving and keeping people away from specialist care. We can see gatekeeping differently however as a way not to ration care but to provide patients with the best care needed at the time for them.

When someone presents to primary care the probability of serious disease is low and therefore the potential to harm, by over-medicalising and over investigating is high¹. By using expert generalism to see people in a holistic way we are able to hold people in the community who do not require specialist care and prevent iatrogenic harm. We know that for every symptom a person presents to a doctor with there is a social and relational context that is part of and contributes to their illness experience at that time. Often the most difficult presentations to deal with are people with ​persisting physical symptoms or distress where no biomedical/pathological explanation can be identified. We will return to these concepts more later but disentangling these tricky problems is where we need expert generalist practice.

How do you see your role in gatekeeping? Do you feel uncomfortable with this part of our job?

References

1. Van Dijk, W., Faber, M. J., Tanke, M. A. C., Jeurissen, P. P. T., & Westert, G. P. (2016). Medicalisation and Overdiagnosis: What Society Does to Medicine. International Journal of Health Policy and Management, 5(11), 619–622. https://doi.org/10.15171/ijhpm.2016.121