Teaching and patient payment

To the Editor: A recent interview-based study of the experience of 60 general practitioner teachers in Brisbane1 found that private, fee-paying patients were perceived by a number of participants as being less accepting of active student involvement in teaching consultations than those in bulk-billing practices. Some examples of a perceived relationship between patient payment and patient attitudes — and perhaps obligations (although no participants explicitly related non-payment for health care with an increased patient obligation to assist with doctor training) — in relation to teaching are provided in the Box. Arguably, there is an implication that private fee-paying patients may be more inclined to be litigious in the event of an adverse outcome associated with teaching, and that these patients may choose to obtain their general practice care elsewhere if they are imposed on. These perceptions are likely to influence GPs’ decisions to seek patient consent for active student learning.