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Framing the doctor-patient relationship in chronic illness: a comparative study of general practitioners' accounts

Framing the doctor-patient relationship in chronic illness: a comparative study of general practitioners' accounts
Framing the doctor-patient relationship in chronic illness: a comparative study of general practitioners' accounts
How family doctors conceptualise chronic illness in the consultation has important implications for both the delivery of medical care, and its experience by patients. In this paper, we present the results of a re-analysis of qualitative data collected in a series of studies of British family doctors between 1995 and 2001, to explore the ways in which the legitimacy and authority of medical knowledge and practice are organised and worked out in relation to three kinds of chronic illness (menorrhagia; depression; and chronic low back pain/medically unexplained symptoms).

We present a comparative analysis of (a) the moral evaluation of the patient (and judgements about the legitimacy of symptom presentation); (b) the possibilities of disposal; and (c) doctors’ empathic responses to the patient, in each of these clinical cases. Our analysis defines some of the fundamental conditions through which general practitioners frame their relationships with patients presenting complex but sometimes diffuse combinations of ‘social’, ‘psychological’ and ‘medical’ symptoms. These are fundamental to, yet barely touched by, the increasingly voluminous literature on how doctors should interact with patients.

Moving beyond the individual studies from which our data are drawn, we have outlined some of the highly complex and demanding features of what is often seen as routine and unrewarding medical work, and some of the key requirements for the local negotiation of patients’ problems and their meanings (for both patients and doctors) in everyday general practice.
physician-patient interaction, chronic illness, qualitative methods, chronic back pain, menorrhagia, depression, medically unexplained symptoms
0141-9889
135-158
May, Carl
17697f8d-98f6-40d3-9cc0-022f04009ae4
Allison, Gayle
6952e1f1-3719-4fec-9168-c2fde8c44d8a
Chapple, Alison
00321aef-923f-493c-855c-2e5dd72e95b3
Chew-Graham, Carolyn
530beade-2b1c-4eea-846f-1fcef0585ca5
Dixon, Clare
10c9d095-651f-4ef1-ae70-0c5de1391200
Gask, Linda
9805a757-54f2-400c-b3f4-b5cc277df509
Graham, Ruth
51cb25c6-246e-4e22-811c-c5d3cf89cebf
Rogers, Anne
cac0b774-b6bf-4e22-bee6-03551d0730c7
Roland, Martin
a938cadd-11c8-4f18-8b74-5da81c1a6a27
May, Carl
17697f8d-98f6-40d3-9cc0-022f04009ae4
Allison, Gayle
6952e1f1-3719-4fec-9168-c2fde8c44d8a
Chapple, Alison
00321aef-923f-493c-855c-2e5dd72e95b3
Chew-Graham, Carolyn
530beade-2b1c-4eea-846f-1fcef0585ca5
Dixon, Clare
10c9d095-651f-4ef1-ae70-0c5de1391200
Gask, Linda
9805a757-54f2-400c-b3f4-b5cc277df509
Graham, Ruth
51cb25c6-246e-4e22-811c-c5d3cf89cebf
Rogers, Anne
cac0b774-b6bf-4e22-bee6-03551d0730c7
Roland, Martin
a938cadd-11c8-4f18-8b74-5da81c1a6a27

May, Carl, Allison, Gayle, Chapple, Alison, Chew-Graham, Carolyn, Dixon, Clare, Gask, Linda, Graham, Ruth, Rogers, Anne and Roland, Martin (2004) Framing the doctor-patient relationship in chronic illness: a comparative study of general practitioners' accounts. Sociology of Health and Illness, 26 (2), 135-158. (doi:10.1111/j.1467-9566.2004.00384.x).

Record type: Article

Abstract

How family doctors conceptualise chronic illness in the consultation has important implications for both the delivery of medical care, and its experience by patients. In this paper, we present the results of a re-analysis of qualitative data collected in a series of studies of British family doctors between 1995 and 2001, to explore the ways in which the legitimacy and authority of medical knowledge and practice are organised and worked out in relation to three kinds of chronic illness (menorrhagia; depression; and chronic low back pain/medically unexplained symptoms).

We present a comparative analysis of (a) the moral evaluation of the patient (and judgements about the legitimacy of symptom presentation); (b) the possibilities of disposal; and (c) doctors’ empathic responses to the patient, in each of these clinical cases. Our analysis defines some of the fundamental conditions through which general practitioners frame their relationships with patients presenting complex but sometimes diffuse combinations of ‘social’, ‘psychological’ and ‘medical’ symptoms. These are fundamental to, yet barely touched by, the increasingly voluminous literature on how doctors should interact with patients.

Moving beyond the individual studies from which our data are drawn, we have outlined some of the highly complex and demanding features of what is often seen as routine and unrewarding medical work, and some of the key requirements for the local negotiation of patients’ problems and their meanings (for both patients and doctors) in everyday general practice.

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More information

Published date: March 2004
Keywords: physician-patient interaction, chronic illness, qualitative methods, chronic back pain, menorrhagia, depression, medically unexplained symptoms

Identifiers

Local EPrints ID: 163517
URI: https://eprints.soton.ac.uk/id/eprint/163517
ISSN: 0141-9889
PURE UUID: 15bf167f-b205-4ec6-871c-53880b5196fe
ORCID for Carl May: ORCID iD orcid.org/0000-0002-0451-2690

Catalogue record

Date deposited: 09 Sep 2010 11:28
Last modified: 10 Dec 2019 01:39

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Contributors

Author: Carl May ORCID iD
Author: Gayle Allison
Author: Alison Chapple
Author: Carolyn Chew-Graham
Author: Clare Dixon
Author: Linda Gask
Author: Ruth Graham
Author: Anne Rogers
Author: Martin Roland

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