{"id":421558,"date":"2026-05-11T01:19:10","date_gmt":"2026-05-11T01:19:10","guid":{"rendered":"https:\/\/www.newsbeep.com\/nz\/421558\/"},"modified":"2026-05-11T01:19:10","modified_gmt":"2026-05-11T01:19:10","slug":"doctors-can-act-as-gatekeepers-or-brokers-for-patients-how-they-decide-can-be-crucial","status":"publish","type":"post","link":"https:\/\/www.newsbeep.com\/nz\/421558\/","title":{"rendered":"Doctors Can Act As Gatekeepers Or Brokers For Patients \u2013 How They Decide Can Be Crucial"},"content":{"rendered":"

\"The<\/a>
\nMonday, 11 May 2026, 8:49 am
Article: The Conversation<\/a><\/p>\n

\n
Kevin
\nDew<\/a>, Te
\nHerenga Waka \u2014 Victoria University of Wellington<\/a>;
\nChris
\nCunningham<\/a>, Te
\nKunenga ki P\u016brehuroa \u2013 Massey University<\/a>; Elizabeth
\nDennett<\/a>, University
\nof Otago<\/a>; Kerry
\nChamberlain<\/a>, Te
\nKunenga ki P\u016brehuroa \u2013 Massey University<\/a>, and Richard
\nEgan<\/a>, University
\nof Otago<\/a><\/p>\n

General practitioners (GPs)
\nand hospital doctors are usually the first contact point for
\npatients, but as our new research<\/a>
\nshows, they can take on different roles, acting either as
\ngatekeepers or brokers.<\/p>\n

As gatekeepers they make
\nsure unnecessary investigations are avoided and scarce
\nresources used efficiently. As brokers, they advocate for
\ntheir patients\u2019 access to the limited resources available.\n<\/p>\n

Advertisement – scroll to continue reading<\/p>\n

For people living with life-limiting disease, the
\nrole a doctor adopts can mean the difference between timely
\ncare and dangerous delay.<\/p>\n

Our research focused on
\npeople who had lived with a terminal cancer diagnosis for a
\nlong time. The impact of these different roles can be seen
\nclearly. <\/p>\n

When GPs were concerned a person\u2019s
\nsymptoms could indicate cancer, most patients were referred
\nto specialist services quickly so diagnostic work could be
\nundertaken. <\/p>\n

But there were also cases where
\npatients, even with a history of cancer, were not referred
\nquickly. There are several reasons why this might occur.\n<\/p>\n

One is that the GP thinks the
\npatient\u2019s symptoms are due to a different condition. For
\nexample, one of the people in our study had a history of
\nbreast cancer, but also of mental health issues. When they
\npresented with breathlessness, their GP prescribed an
\nantidepressant. <\/p>\n

The breathlessness persisted and
\nthe patient returned to the GP and eventually ended up in
\nthe emergency department where they were diagnosed with lung
\nmetastases. <\/p>\n

Another patient had a lump on her
\nbreast ten years after breast cancer. Her GP said it was a
\ncyst, and it was not until she saw a female doctor that she
\nwas sent to her specialist to find the cancer had
\nmetastasised.<\/p>\n

Even in the hospital sector resources
\ncould be withheld from patients. <\/p>\n

One study
\nparticipant was found to have a terminal brain tumour and
\nwas sent home and told treatment would be \u201ca waste of
\ntime\u201d. It was only due to the tenacity of their spouse
\nthat the patient was eventually sent for possible
\ntreatment.<\/p>\n

Doctors as advocates<\/p>\n

In
\ncontrast, for some patients a health professional will
\nbroker access to resources others might not be given.\n<\/p>\n

Again, reasons for this vary, but can often come
\ndown to some assessment about who is worthy of this extra
\neffort. <\/p>\n

One of the patients we spoke to had
\nmalignant melanoma that had been misdiagnosed years earlier
\nas benign. Their specialist went in to bat for them, working
\nto get them onto a vaccine trial, trying to make up for that
\nsystem failure. <\/p>\n

Another patient, a medical
\nprofessional, was one of only 100 people in New Zealand put
\non an unsubsidised medication at no cost to them. Yet
\nanother, who was in their 30s, was placed on a number of
\ntrials for melanoma, even in circumstances where they did
\nnot meet the trial protocol.<\/p>\n

We can see some clear
\nreasons why a health professional may broker access to
\nscarce resources for their patient. The patient may have
\nbeen let down by the health system earlier, they may have
\nstrong connections with the health system because of their
\nwork, and they may be regarded as being more worthy because
\nof their age.<\/p>\n

There will be many other factors, but
\nwe have no systematic research on this issue. What we do
\nhave, though, is a situation where health professionals are
\nmaking determinations about who is worthy of access to
\nresources. <\/p>\n

These decisions are not mere judgements
\nabout need or likely clinical
\nbenefits.<\/p>\n

Reinforcing existing
\ninequities<\/p>\n

For M\u0101ori, gatekeeping and brokering
\nmay have very different effects. <\/p>\n

Gatekeeping may
\nnot be malicious but can reproduce the experience of later
\ndiagnosis and poorer outcomes, which is already
\nmore common for M\u0101ori<\/a>. <\/p>\n

M\u0101ori are also less
\nlikely to start with the advantages that make a patient
\n\u201cbroker-worthy\u201d. If brokerage is informal and
\ndiscretionary, it risks reinforcing inequities the system
\nnominally wants to reduce.<\/p>\n

A third role we saw was
\nless about tests and treatments and more about what kinds of
\nknowledge and practice are allowed into the clinic. Some
\npractitioners acted as boundary enforcers, defending the
\nedge of Western evidence-based medicine by excluding or
\nignoring other approaches to cancer and healing.\n<\/p>\n

One patient in our study rejected Western
\nmedicine, concluding that doctors did not listen to them or
\nunderstand their cultural and spiritual world.<\/p>\n

GPs
\nand hospital specialists will always have to balance finite
\nresources, uncertain evidence and competing obligations. But
\nwhether they primarily act as gatekeepers, brokers, boundary
\nenforcers or as bridge builders across these roles has real
\nconsequences for who is diagnosed, who is treated, and who
\nlives well with cancer in Aotearoa. <\/p>\n

For M\u0101ori,
\nwhose cancer journeys are already shaped by structural
\ninequity<\/a>, getting those roles right is not an abstract
\npolicy debate. It is a matter of life and death.\n<\/p>\n

We need to understand medical practitioners\u2019
\ndecisions about which role they take on. This knowledge may
\nhelp patients to advocate for themselves and researchers to
\nanalyse whether these decisions are fostering equitable
\noutcomes.\"The<\/p>\n

Kevin
\nDew<\/a>, Professor of Sociology, Te
\nHerenga Waka \u2014 Victoria University of Wellington<\/a>;
\nChris
\nCunningham<\/a>, Professor of M\u0101ori and Public Health,
\nTe
\nKunenga ki P\u016brehuroa \u2013 Massey University<\/a>; Elizabeth
\nDennett<\/a>, Associate Professor of Surgery, University
\nof Otago<\/a>; Kerry
\nChamberlain<\/a>, Professor of Social and Health Psychology,
\nTe
\nKunenga ki P\u016brehuroa \u2013 Massey University<\/a>, and Richard
\nEgan<\/a>, Associate Professor of Health Promotion, University
\nof Otago<\/a><\/p>\n

This article is
\nrepublished from The
\nConversation<\/a> under a Creative Commons license. Read the
\noriginal
\narticle<\/a>.<\/p>\n

<\/p>\n","protected":false},"excerpt":{"rendered":"Monday, 11 May 2026, 8:49 amArticle: The Conversation Kevin Dew, Te Herenga Waka \u2014 Victoria University of Wellington;…\n","protected":false},"author":2,"featured_media":35750,"comment_status":"","ping_status":"","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[10],"tags":[219,134,7057,3274,111,24636,139,69,147673,11112,1105],"class_list":["post-421558","post","type-post","status-publish","format-standard","has-post-thumbnail","category-health","tag-economy","tag-health","tag-healthcare-industry","tag-hospitals","tag-new-zealand","tag-newsworthy","tag-newzealand","tag-nz","tag-primary-health","tag-scoop","tag-the-conversation"],"_links":{"self":[{"href":"https:\/\/www.newsbeep.com\/nz\/wp-json\/wp\/v2\/posts\/421558","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.newsbeep.com\/nz\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.newsbeep.com\/nz\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.newsbeep.com\/nz\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/www.newsbeep.com\/nz\/wp-json\/wp\/v2\/comments?post=421558"}],"version-history":[{"count":0,"href":"https:\/\/www.newsbeep.com\/nz\/wp-json\/wp\/v2\/posts\/421558\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/www.newsbeep.com\/nz\/wp-json\/wp\/v2\/media\/35750"}],"wp:attachment":[{"href":"https:\/\/www.newsbeep.com\/nz\/wp-json\/wp\/v2\/media?parent=421558"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.newsbeep.com\/nz\/wp-json\/wp\/v2\/categories?post=421558"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.newsbeep.com\/nz\/wp-json\/wp\/v2\/tags?post=421558"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}