Abstract
BackgroundPatients with type 2 diabetes mellitus (T2DM) with poor glycaemic control can represent a challenge from the perspective of the general practitioner (GP). Apart from patient-sided factors, the understanding of GPs’ attitudes may provide ideas for improved management in these patients. The aim of this study is to reveal attitudes of GPs towards T2DM patients with poor metabolic control.MethodsQualitative research in German general practice; 20 GPs, randomly chosen from participants of a larger study; in-depth narrative interviews, audio-recorded and transcribed; inductive coding and categorisation in a multi-professional team; abstraction of major themes in terms of attitudinal responses.Results1) Orientation on laboratory parameters: GPs see it as their medical responsibility to achieve targets, which instil a sense of security. 2) Resignation: GPs believe their efforts are in vain and see their role as being undermined. 3) Devaluation of the patient: GPs blame the “non-compliance” of the patients and experience care as a series of conflicts. 4) Fixed role structure: The expert GP on the one hand, the ignorant patient on the other. 5) Solidarity with the patient: GPs appreciate a doctor-patient relationship in terms of partnership.ConclusionsThe conflict GPs experience between their sense of duty and feelings of futility may lead to perceptions such as personal defeat and insecurity. GPs (and patients) may benefit from adjusting the patient-doctor relationship with regard to shared definitions of realistic and authentic goals.
Highlights
Patients with type 2 diabetes mellitus (T2DM) with poor glycaemic control can represent a challenge from the perspective of the general practitioner (GP)
The conflict GPs experience between their sense of duty and feelings of futility may lead to perceptions such as personal defeat and insecurity
The GP was asked to talk about a second T2DM patient which had been previously selected from the patient list for inclusion in the overall mixed methods project: “You have reported to the project both well-controlled and poorly controlled diabetes patients
Summary
Patients with type 2 diabetes mellitus (T2DM) with poor glycaemic control can represent a challenge from the perspective of the general practitioner (GP). Apart from patient-sided factors, the understanding of GPs’ attitudes may provide ideas for improved management in these patients. The aim of this study is to reveal attitudes of GPs towards T2DM patients with poor metabolic control. Attitudes have been shown to have an effect on observable behaviour [2] – a fact that underlies several theories of explaining or changing behaviour [3]. The observable behaviour of practitioners (i.e. doctor-patient communication, e.g. in terms of the development of therapeutic aims) can be influenced by the practitioners’ attitudes towards a patient [6, 7]. Professional behaviour (i.e. the GP’s communication style and technique) exerts its effects on patient outcomes by several routes [8]
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