Table 2

Quotes pathway

(A) Pathway A: direct to the ED
Subgroup A1
‘doc to go’
Subgroup A2
Focused visit: X-ray required
Subgroup A3
Seeking higher medical standards
Subgroup A4
Worried patients
“Well, it's the extreme waiting times at the GP, or all that. It's something I just can't do. So, when I have something urgent, then I usually go to the hospital and when it isn't so urgent, I just treat myself a bit” (P09U).
“Well, I simply can't do between 9.30 and 7 o'clock in the evening, anything medical” (P27U).
“I'm self-employed and always have to go to work. I don't have time to sit down in a doctor's waiting room. That's too stressful for me. To sit around for so long and nothing comes out of it” (P26R).
“No, I don't have one (GP). I don't really go/I don't get ill. But I should go some time, haha, and I guess I should have a GP, but then I always forget, but I should be doing it” (P26U).
“Before I go to the GP, I don't think he is even open today, I have to wait until tomorrow and then he's only open between 4 and 6, then I get there, have to wait around, and they then only give you a referral to a surgeon or an X-ray department and then this is probably a quicker way, I think” (P3R).
And your GP can't do it?
“No, because X-ray is needed and everything” (P12R).
“I've twisted my ankle and that needs X-ray, I suppose, probably” (P8R).
“Then you go straight away to the ED, in such a case, because GP can't do much, because he has no X-ray at hand” (P7R).
“And I always feel that the hospital safer, there are many more possibilities, the GP is too limited to little things, but taking blood sample doesn't work, will take 2 or 3 days, for example. Or urine, urine is a bit quicker, I mean than taking blood, but here it takes an hour, and all is done, blood, urine everything”(P40U).
“I'm here with my heart condition and came here for other things as well, I like it here, feel looked after, because I had a deep thrombosis, and then I went to another hospital, and they made me look as if I was just faking it” (P3U).
“Yeah, and they gave me a jab, well the GP did, and I'd say, you know, the injections they do here, are not the same as the ones, you know, here at the ED and then, there's a surgeon here, probably, who does it and I reckon it's going to be a bit more professional, like, and I've heard they have different gear here, that the medicines what they inject, are, let's say, more effective” (TN 29R).
“It's only psyche and nothing more and I shouldn't exaggerate and then he had realized that is was actually worse and then had I, and then I immediately said I would like a referral to (Place of ED) and then I had gotten it and now I'm sitting here” (P20R).
“I already told him (GP) about my problem but he said it wasn't anything and that's why I'm here, now” (P20U).
(B) Pathway B: visiting ED after an unsuccessful attempt to see a resident doctor
Subgroup B1: subacute demand for treatmentSubgroup B2: acute demand for treatment
“Then I tried to find an orthopedic surgeon here in this area, no chance, you've got no chance. Phoning them doesn't work, they just tell you, they can give you an appointment in 4 months” (P19R).
“The doctor looked at the blood test and said: that all has to be analyzed more thoroughly and he referred me. Then I called lot of docs and was given appointments from between 3 and 5 months from now. I'm worried about the problem, more and more, day by day (…) It just took too long and then I thought, I just come here. Maybe I'll get a check-up and then I get the results and know what to do next” (P18U).
“I tried to see some kind of a GP or surgeon, but the next appointments were in a month time, I mean I've definitely got one, let's say a whole network of doctors but none who would have been able to do it straight away. So I tried, but it just didn't work out” (P27U).
“Yeah, on Saturday I had a little accident—got stuck in the back of my hand, stuck in the thorns, they tore into me and I didn't manage to get them all out. Now my whole hand is swollen up. That's why I ended up going to the surgeon this morning, one I've never been to—the waiting room was packed, saw it straight away and him from reception told me, the earliest I could get an appointment was next Monday, so in a weeks’ time. That's why I went to the ED” (P1R).
“Well, I've got a problem with my eyes, my skin, my scalp and it got worse the last few days, so I called five dermatologists today, but it's not possible to see one without a date (…) This problem isn't new to me, it's for some time” (P37U).
(C) Pathway C: referral by the outpatient provider
Subgroup C1: reference due to time issuesSubgroup C2: reference due to challenging symptoms
“Exactly, yes, my knee is so weak. And then, today, I'd go to my orthopedist, but all of them were in holidays, and the substitute had too much to do, he'd said, if you have pain, go to (Site I) we have too much to do, so you can have an appointment in 8 days, 8 days later, and then I said: No, this doesn't work. And he answered: either you go to (Site I) or you have to wait until your doctor is back’” (P38U).
“I've called the emergency service (of the associations of statutory health insurance registered doctors) and asked where is the best to go. You know, my office is in X street, and they suggested to go here directly” (P30U).
 “I first went to my GP and he reckoned, these blood think is not ok. It's much too high. Terrible. That's why I came her” (P15U).
Participants daughter: (Mother suffers from) “headaches, then we went to the doctor, he said, go to the ED, that'd much better” (P23U).
“The GP said I should go straight to hospital to have it checked out because they have different means than they do have at the local countryside surgery” (P7R).
  • ED, emergency department; GP, general practitioner; n, No of Participants; P n R, Participants from Rural Region; P n U, Participants from Urban Region.