Objectives To explore barriers to patients being referred for possible reva
scularisation.
Design Qualitative study using semi-structured interviews.
Participants 16 patients aged under 75 years with stable angina and their d
octors.
Setting General practice in Toxteth, Liverpool.
Results Fear of both hospitals and medical tests was common and largely hid
den from the doctors. Patients felt they were old, had low expectations of
treatment, viewed angina as a chronic illness, and knew little about new de
velopments in angina treatment Patients and doctors had difficulty in recog
nising angina symptoms that were not textbook definitions amid multiple com
orbidity. Patients saw doctors as busy and did not want to bother them with
their condition. Cultural gaps and communication difficulties existed desp
ite all but one patient having English as their first language.
Conclusions Listening to patients is vital to address inequitable access to
health services: how patients are treated by doctors today affects accepta
bility of referral tomorrow. Primary care groups in deprived areas should w
ork With communities to address local fears. This will involve collaboratio
n between primary, secondary, and tertiary care. Cultural gaps exist betwee
n patients and doctors in deprived areas, and diagnostic confusion can occu
r particularly in die presence of other psychological and physical morbidit
y. Adequate time and resources-for example, education for doctors and patie
nts and provision of interpreters-need to he provided if inequitable access
to revascularisation procedures is to be addressed.