Table 4 Themes and categories of reasons for disagreement regarding illnesses between older patients with multimorbidity and their GPs

Category

GP

Patient

1

Problems with communication and cooperation between health care professionals

The hospital communicates many diagnoses that the general practitioner considered incorrect or exaggerated

×

×

The specialist explains his findings too little and / or responds insufficiently towards the patient

×

×

The GP is not/ or inadequately informed by the specialists, e.g. because no medical report is transferred

×

×

The GP is not involved in the treatment by the specialist

×

×

The patient reluctantly reports being treated by an alternative practitioner

×

2

Disease management by GP and patient

The GP’s and patient’s understanding of a disease agree more in diagnoses requiring regular disease management

×

×

The GP’s diagnostic process is more difficult, if the examination of the patient is uncomfortable for the GP or he/she does not feel responsible

×

×

The complexity of a single or multiple diseases complicates the GP’s diagnostic process and the clinical management, as seen for example in multimorbidity

×

×

In patients who take own initiatives, there is a greater consistency in disease understanding between GP and patient

×

3

Documentation behaviour of the GP

The pressure from health insurances to encode certain diseases, affects the documentation behaviour of the GP

×

Whether a disease is diagnosed by the GP or not, depends on the disease stage and measured values

×

×

Not all symptoms are documented by the GP as diseases

×

×

The GP has little knowledge about diseases that are lie far in the patients’ pasts

×

×

Errors in the patient record cannot be corrected subsequently, e.g. in the hospitals’ or GPs’ records

×

×

4

Communication challenges between GP and patient

There is too little time to discuss complaints and diseases to achieve a mutual understanding

×

×

The GPs’ medical understanding of illnesses must be translated into the patients’ level of understanding and vice versa

×

×

The consultation can be exhausting and this may cause something to be forgotten or missed

×

The exchange of information and disease management are dependent on the doctor-patient relationship and the mutual trust

×

×

Agreement on understanding a disease is worse in patients who are difficult to lead and / or functionally impaired

×

5

Differences in the understanding of a disease between GP and patient

Information that is given by specialists and / or elaborate diagnostics are formative for the patient

×

The patients’ clinical pictures are influenced by the media and campaigns

×

×

The GPs’ medical understanding of an illness deviates from the patients’ everyday understanding

×

×

6

Prioritization and rating of diseases by GP and patient

The GP prioritizes diseases that affect the prognosis of the patient

×

The patient prioritizes diseases associated with complaints

×

Diseases that are not relevant for the patient from a general practitioner's point of view are not communicated to the patient

×

Diseases that are not relevant for the GP, from a patient’s perspective, are not communicated to the GP

×

×

7

Obliviousness, repression and avoidance by the patient

The patient does not remember diseases if they are too far in the past

×

×

Diseases are repressed by the patient, e.g. cancer

×

×

The patient conceals embarrassing diseases

×

×

The patient tries to avoid the utilization of health services

×

×