Desire Paths in Patient Care

Maiedha Raza is an associate professor in primary care medical education at Black Country Medical School and a GP

A ‘desire path’ is known in planning terms as an informal route created when built pathways do not reflect how people naturally move. In urban planning, these are the worn tracks across grass where people choose a quicker or easier route.¹ In primary care, we see similar patterns emerge.

Desire paths in primary care, are those informal, patient-driven routes through services that emerge outside of prescribed systems. They highlight the importance of communication skills in shaping access and experience. In practice, we see patients often “create” these paths when formal channels feel inaccessible, unclear, or unresponsive.

As GPs, we are acutely aware that effective communication is a relational process that builds trust and navigational clarity. When clinicians engage in active listening and show empathy, they reduce the likelihood that patients will seek alternative, potentially less appropriate routes of care. This aligns with the principles of patient-centred communication, which emphasises understanding the patient’s perspective and context as foundational to safe and effective practice.²

From a reflective standpoint, communication breakdowns often underpin the formation of desire paths. Patients may bypass GPs for instance, due to perceived barriers such as difficulty securing appointments or feeling unheard during consultations. This suggests that clarity, consistency, and responsiveness in communication are critical. Techniques such as checking understanding can help ensure that patients leave consultations with a clear sense of next steps and available support. The literature supports that unclear communication is associated with decreased patient satisfaction and increased service inefficiencies, reinforcing the need for deliberate and skilled interaction.³

if I reflect on my own practice, I recognise that communication skills must be adaptive and culturally sensitive to effectively address diverse patient needs. Desire paths may disproportionately arise among vulnerable populations who experience systemic inequities or language barriers. Employing strategies such as culturally competent approaches can mitigate these risks. Reflective practice itself serves as a tool for continuous improvement. By acknowledging how communication influences patient behaviour and system navigation, practitioners can contribute to more equitable and efficient care pathways. Thus, strengthening communication skills is not only a professional competency but also a means of reshaping the informal “desire paths” into safer, more integrated primary care journeys.

References

1. https://www.theguardian.com/cities/2018/oct/05/desire-paths-the-illicit-trails-that-defy-the-urban-planners [accessed 14/8/26]
2. Silverman, J., Kurtz, S., & Draper, J. (2013). Skills for Communicating with Patients (3rd ed.). Radcliffe Publishing.
3. Ong, L. M., de Haes, J. C., Hoos, A. M., & Lammes, F. B. (1995). Doctor–patient communication: A review of the literature. Social Science & Medicine, 40(7), 903–918

Featured Photo by Anisur Rahman on Unsplash