Abstract:
This thesis explores the journey to primary care experienced by 'marginalised' patients, focusing in particular on their views and experiences of general practice waiting rooms and reception processes. The study draws on encounters with 13 participants recruited with the assistance of non government organisations (NGOs) in Whangarei, the most northerly city in New Zealand. These NGOs serve communities of interest whose members, previous research suggests, may report greater-than-typical difficulties in accessing general practitioners. Participants drew pictures and discussed their experiences of ideal and less than ideal waiting rooms and receptionist interactions. A shared analysis of the drawings, underpinned by a visual participatory research methodology and kaupapa Māori research principles, was undertaken through a grounded theory approach. Three broad themes were identified: ‘Homelessness’ in the waiting room, ‘Privileged Visibility’ and the waiting room as a ‘Dressing Room”. Creating a sense of place within waiting rooms requires an avoidance of 'othering' and discrimination. In addition, receptionists who undertake emotional communication may further enhance hospitality and the avoidance of ‘figurative exclusion’ from the waiting room. ‘Figurative exclusion’ from the waiting room results in anticipatory waiting as people prepare to become patients. The thesis concludes that the critical interface between communities and general practice is the waiting room. Transforming general practice towards an empowering model of primary health care requires a transformation of how receptionists engage with people and how waiting rooms facilitate and incorporate their spatio-temporal rhythms. These changes will require far reaching and potentially disruptive changes to the current model of general practice.
