Table 2

Factors Considered and Quotations

FactorQuotation
Orientation to the situation
 What is being requested?
  • 1. “If it’s at a party, then the answer’s ‘no.’ At that moment, I’m not a physician, just a guest at the party. Unless, of course, that it’s something very serious, a life-or-death situation that I have to deal with. Otherwise, they need to go to their own physician or call me at another time. And then if it’s something really serious, I still advise them to go to their own physician.” [JP20, FG3]

 Where are we?
  • 2. “If I were talking one-on-one to someone face-to-face, at somebody’s house, and he asks me something, then I am much more inclined to listen, to have a look, or to listen further than I would if I were, for example, at a party. I don’t think that’s the time or place. I am busy doing something else. And neither do you have the peace and quiet to listen properly, so I am always much more circumspect in that sort of environment.” [JP25, FG4]

 Who is making the request?
  • 3. “So it has a lot to do with how much compassion I have with somebody whether I will say, ‘I’ll just draw that from my magician’s hat for I know the answer!’” [SP15, FG7]

Nature and strength of the relationship with the nonpatient
  • 4. “If it were the neighbor’s wife, then I think it would be different. I think I would have said, ‘Your physician has examined you, so now wait for the results.’ But because it’s your own mother, you are therefore more worried, you go one step further. You travel that extra mile for your own family.” [JP22, FG4]

  • 5. “For example, if you see a blemish and you suspect it is a basal cell carcinoma or something, with a family member or a good friend you are just not going to say nothing. You would say something like, ‘You should go to the physician because I don’t like the look of that spot you have got there.’” [SP15, FG7]

  • 6. “You have the knowledge. And if I say to an IT expert, ‘Hey, have a look at this will you? My computer won’t work,’ you expect to get a simple answer. So I therefore thought that I should also be a bit more relaxed in my attitude. I have been more so over the past few years. With family too.” [SP12, FG7]

  • 7. “Just say, you hear something from your father and you don’t say anything about it. Your father will then assume, ‘Oh, she heard it and has said nothing, so then it’s probably alright.’ So it’s a matter of my responsibility towards my family, but your family does expect you to do something if there’s a problem.” [JP27, FG5]

Amount of trust in one’s own knowledge and skills
  • 8. “As long as I have no doubts. If I have doubts, then I would certainly just say go to see your own physician.” [JP16, FG3]

  • 9. “I am conscious of this, because if I know that you probably are less careful in your examination, and that you probably don’t think it’s pleasant to contemplate that there could be something seriously amiss with a member of your family. And that you therefore would prefer not to go looking for something. So I am very aware … and thus alert to the situation. And I am convinced that if I am alert to what’s going on, it will turn out alright.” [SP4, FG6]

  • 10. “Coincidentally, that happened to me recently. Someone had shaved her legs with a razor and sent me 3 photos asking me what she should do. And then I answered, very clearly, ‘I haven’t seen the full picture. I don’t know the whole story.’ This is the sort of situation that I keep myself well away from.” [JP2, FG3]

  • 11. “Sometimes, I have a blind spot as far as members of my family are concerned. Things that I just don’t see or perceive as being less serious than they really are.” [SP11, FG7]

Expected consequences of making mistakes
  • 12. “Things can sometimes just go wrong in the medical profession, but I would be scared of being blamed for this. I wouldn’t like to be blamed, let’s say, by a family member or a good friend. They are my close friends, and I enjoy a good relationship with them. And I want to keep it like that.” [JP23, FG4]

  • 13. “You don’t want to have it on your conscience if, for example, you have taken a step backwards and therefore no action has been taken, and something serious is missed. With anyone, I mean a normal patient let alone a member of your own family. Then there’s also a level of personal involvement.” [JP30, FG5]

Importance of work-life balance
  • 14. “Really, I would prefer it if, when I am finished with work, then I am really finished. I am then not very interested in examining people and so forth. I see being a physician more as a profession, not as my identity as a person. That’s what I hope to stay feeling and what I really want to be the case.” [JP11, FG2]

  • 15. “I have certainly learned over time how to split the 2 roles in my head. As a family physician just starting out, you gave well-intentioned advice or you listened to the complaints of family members, then you recognize that the roles of family member and physician are interwoven in the words that you choose or the interventions that you carried out. Eventually, you become more aware of just what cap you are wearing at any given time.” [SP2, FG6]

Risk of disturbing the physician-patient process
  • 16. “It is also good that the patient’s own family physician is able to keep tabs on things … So if I go ahead and sort out problems for people and they have, for example, the same trouble every month, the physician will be unaware that this is a recurrent problem each month … and loses the overview.” [JP25, FG4]

  • FG=focus group; IT=information technology; JP=junior physician; SP=senior physician.