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General practitioners (GPs) are often considered central to this aim. Although GPs facilitate early disease detection, disease prevention and coordinated medical care, they must do so while aiming to protect both patients and the healthcare system from the harmful effects of medical overactivity. Public healthcare systems with gatekeeping practices, such as Denmark, lack many of the identified economic and structural incentives for LVC. Why then does LVC persist? Drawing on ethnographic observations and interviews with practising GPs, we explore how Danish GPs handle the difficult task of drawing a line between what requires medical attention and what should be left untreated or monitored. Our findings suggest that LVC literature may overlook the value of some\u00a0interventions when used by\u00a0GPs to improve patient trajectories over a longer term, maintain the relationship between patient and practitioner or balance the use of time and resources across the healthcare system. We clarify this point by unpacking the relational and context\u2010dependent work of GPs, which is central to their capacity to serve as trusted gatekeepers.<\/jats:p>","DOI":"10.1111\/1467-9566.70034","type":"journal-article","created":{"date-parts":[[2025,4,15]],"date-time":"2025-04-15T01:44:01Z","timestamp":1744681441000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["The Gatekeeper's Dilemma: Unpacking the Complexity of Low\u2010Value Care in General Practice"],"prefix":"10.1111","volume":"47","author":[{"ORCID":"https:\/\/orcid.org\/0009-0003-7041-3185","authenticated-orcid":false,"given":"Olivia","family":"Spalletta","sequence":"first","affiliation":[{"name":"Department of Science Education Section for History and Philosophy of Science University of Copenhagen  Copenhagen Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7011-7202","authenticated-orcid":false,"given":"Sara","family":"Green","sequence":"additional","affiliation":[{"name":"Department of Science Education Section for History and Philosophy of Science University of Copenhagen  Copenhagen Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2025,4,14]]},"reference":[{"key":"e_1_2_13_2_1","doi-asserted-by":"publisher","DOI":"10.1146\/annurev\u2010soc\u2010121919\u2010054719"},{"key":"e_1_2_13_3_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.j84"},{"key":"e_1_2_13_4_1","doi-asserted-by":"publisher","DOI":"10.5694\/mja2.51331"},{"issue":"1","key":"e_1_2_13_5_1","first-page":"i","article-title":"Denmark: Health System Review","volume":"26","author":"Birk H. 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Conceptualising Ethical Dilemmas Arising From Clinical Implementation of Advancing Medical Technology.\u201d PhD thesis Norwegian University of Science and Technology."},{"key":"e_1_2_13_12_1","doi-asserted-by":"publisher","DOI":"10.2307\/j.ctv1ghv4s4"},{"key":"e_1_2_13_13_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj\u20102024\u2010080460"},{"key":"e_1_2_13_14_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen\u20102017\u2010021161"},{"key":"e_1_2_13_15_1","doi-asserted-by":"publisher","DOI":"10.1177\/0141076817698653"},{"key":"e_1_2_13_16_1","doi-asserted-by":"publisher","DOI":"10.4045\/tidsskr.23.0025"},{"key":"e_1_2_13_17_1","doi-asserted-by":"publisher","DOI":"10.1093\/fampra\/cmt007"},{"key":"e_1_2_13_18_1","volume-title":"Snart er vi alle patienter: Overdiagnostik i medicinske og samfundsfaglige perspektiver","author":"J\u00f8nsson A. B. 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