Frequent attenders' (FAs') phenomenon is one of the major discouraging problems that GPs have to face in their everyday life. As Luciano et al write,1 this proportion of patients generates a great cost for public health systems and considerable workload and frustration for GPs.
However, the institutions seem not to be concerned about the problem, and GPs are left alone to deal with it. Many studies have tried to trace a stereotype of the FAs, showing a high incidence of psychiatric illness and social problems. Luciano et al's article indicates these factors as systematically related to this status and the main reasons for consulting as: being on sick leave, being born outside of the country, and reporting mental health problems.
In Italy, we tried to find out other characteristics of the FAs that could help GPs solve the problem.2,3
These characteristics were examined: number of GP consultations, age, sex, social problems, trust in the doctors, and influence of the mass media. Patients with major diseases that appropriately required a high rate of consultations were excluded.
These characteristics were prominent: lack of trust in the other doctors, influence of the mass media, and conflictual relationships with their disease.
The FA's problem is not only a social and psychiatric matter. Often the misuse and abuse of healthcare system is deliberate. The attitude and the structural bureaucracy of the healthcare system towards the patient very often facilitates the occurrence of FAs' phenomenon.
I think that these differences in results are important and indicate a need for more research of the topic. We need a clear definition of ‘frequent attendance’ that would separate clinical from administrative, psychological, environmental, and misuse aspects. I agree with the authors that a health care system's policy change is required. Also, a number of GPs think that a ticket paid by every patient for consultations, home visits, and other procedures might increase the patient sense of moderation and reduce their attendance without a clinical reason, the way it is for specialistic consultations.