Transformation of family medicine

How is the practice of family medicine affected by increasing management control?

Over the past few decades, there has been an effort to enhance management oversight in primary care, driven by political, economic, and bureaucratic influences. Additionally, the rise of the Evidence-Based Medicine movement, which places a strong emphasis on clinical guidelines, has encouraged this development further. In alignment with this trend, the Swedish Association of Local Authorities and Regions (SALAR or SKR) is actively working towards the establishment of a national system for knowledge-driven management.

As part of this initiative, SALAR is focused on implementing a comprehensive framework involving national clinical guidelines and patient-centered care processes specifically tailored for primary care settings. But the impact of increasing management control on the practice of family medicine in Sweden remains underexplored. Existing international research highlights challenges associated with reconciling a holistic approach in primary care with rigid clinical guidelines, potential ramifications for the doctor-patient relationship, and the complexities of applying guidelines in a complex healthcare reality.

This project seeks to contribute to the understanding of the repercussions of increased management control in primary care. It also aims to explore the ethical dimensions of this development. By shedding light on these issues, the project will be able to provide valuable insights into how increased management control in primary care impacts the practice of family medicine in Sweden.

The overall aim of this research project is to explore how an increased management control in primary care impacts the practice of family medicine. To meet our research objectives, researchers involved have formulated key questions.

1. How does increased management control impact primary care physicians in terms of their relationship with patients, professional autonomy, the balance between reflexive understanding and algorithm-based knowledge, and overall working conditions?
2. What are patients' perspectives on the care provided and their level of involvement in decision-making when healthcare follows a predefined agenda during consultations?
3. Considering the findings, what ethical challenges arise due to heightened management control over physicians, and is there ethical justification for continued progression in this direction?