Knowing patients and knowledge about patients: evidence of modes of reasoning in the consultation?
Knowing patients and knowledge about patients: evidence of modes of reasoning in the consultation?
Background: the idea that the patient is in some way known to the doctor is an important one in general practice. The thrust towards patient-centred medicine, the promotion of open and negotiative consultation skills and the development of a biopsychosocial model of primary care medicine all rely on the patient providing a history composed of more than a list of facts.
Objective: our aim was to explore the nature and importance of doctors' knowledge about patients.
Methods: fifteen GPs audio-recorded 25–30 consultations with consecutive consenting patients. They scored each consultation according to how satisfying they found it. Semi-structured interviews based on a selection of consultations were conducted to draw out the doctor's views on the factors that were important to their satisfaction. The interviews were transcribed verbatim. Qualitative analysis was inductive and iterative.
Results: within doctors' narratives, we found accounts of two ways of ‘knowing' the patient. The first was a deductive mode of reasoning derived from facts about the patient. The facts that were known were specific to the context of the general practice consultation and led to biomedical and biographical knowledge. The second was an inductive mode of reasoning derived from a contextual interpretation of the facts about the patient which resulted in knowledge of their behaviour and cognitions. Both modes of reasoning gave the doctor knowledge of the patient and permitted action by the doctor in the consultation but led to different interpretations of the patient and different experiences of the consultation.
Conclusion: ‘Knowing the patient' is important to the way GPs attribute meaning to their work. Doctors were more likely to identify as ‘known' those patients with whom they adopted an inductive mode of reasoning. In addition, their experience of the consultation was more likely to be positive
consultation, GPs, ‘knowing', knowledge
501-506
Fairhurst, Karen
1ec1717d-ecff-4ccc-8e86-5eda901e13f1
May, Carl
17697f8d-98f6-40d3-9cc0-022f04009ae4
October 2001
Fairhurst, Karen
1ec1717d-ecff-4ccc-8e86-5eda901e13f1
May, Carl
17697f8d-98f6-40d3-9cc0-022f04009ae4
Fairhurst, Karen and May, Carl
(2001)
Knowing patients and knowledge about patients: evidence of modes of reasoning in the consultation?
Family Practice, 18 (5), .
(doi:10.1093/fampra/18.5.501).
Abstract
Background: the idea that the patient is in some way known to the doctor is an important one in general practice. The thrust towards patient-centred medicine, the promotion of open and negotiative consultation skills and the development of a biopsychosocial model of primary care medicine all rely on the patient providing a history composed of more than a list of facts.
Objective: our aim was to explore the nature and importance of doctors' knowledge about patients.
Methods: fifteen GPs audio-recorded 25–30 consultations with consecutive consenting patients. They scored each consultation according to how satisfying they found it. Semi-structured interviews based on a selection of consultations were conducted to draw out the doctor's views on the factors that were important to their satisfaction. The interviews were transcribed verbatim. Qualitative analysis was inductive and iterative.
Results: within doctors' narratives, we found accounts of two ways of ‘knowing' the patient. The first was a deductive mode of reasoning derived from facts about the patient. The facts that were known were specific to the context of the general practice consultation and led to biomedical and biographical knowledge. The second was an inductive mode of reasoning derived from a contextual interpretation of the facts about the patient which resulted in knowledge of their behaviour and cognitions. Both modes of reasoning gave the doctor knowledge of the patient and permitted action by the doctor in the consultation but led to different interpretations of the patient and different experiences of the consultation.
Conclusion: ‘Knowing the patient' is important to the way GPs attribute meaning to their work. Doctors were more likely to identify as ‘known' those patients with whom they adopted an inductive mode of reasoning. In addition, their experience of the consultation was more likely to be positive
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Published date: October 2001
Keywords:
consultation, GPs, ‘knowing', knowledge
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Local EPrints ID: 163673
URI: http://eprints.soton.ac.uk/id/eprint/163673
ISSN: 0263-2136
PURE UUID: c9cd632c-aca9-46fc-bbf2-dec4cf068fc1
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Date deposited: 10 Sep 2010 13:33
Last modified: 14 Mar 2024 02:06
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Author:
Karen Fairhurst
Author:
Carl May
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