Abstract
BackgroundIn medical literature, several principles that define ‘good consultations’ have been outlined. These principles tend to be prescriptive in nature, overlooking the complexity of general practitioners (GPs)’ perspectives of everyday practice. Focusing on perspectives might be particularly relevant, since they may affect decisions and actions. Therefore, the present study adopts a bottom-up approach, analyzing GPs’ narratives about ‘good’ and ‘bad’ consultations. We aimed at describing the range of discourses GPs use in relating on their practice.MethodsSemi-structured interviews were conducted with 19 Belgian GPs. By means of a qualitative analysis, the authors mapped patterns in the interview narratives and described the range of different discourses.ResultsFour discourses were identified: a biomedically-centered discourse, a communication-focused discourse, a problem-solving discourse and a satisfaction-oriented discourse. Each discourse was further specified in terms of predominant themes, problems the GPs prefer to deal with and inherent difficulties. Although most participants used elements from all four discourses, the majority of the GPs relied on an individual set of predominant discourses and focused on a limited number of themes.ConclusionThis study clearly indicates that there is no uniform way in which GPs perceive clinical practice. Each of the participants used a subtle mix of different criteria to define good and bad medical consultations. Some discourse elements appear to be rooted in medical literature, whereas others are of a more personal nature. By focusing on the limitations of each discourse, this study can shed new light on some of the difficulties GPs encounter in their daily practice: being confronted with specific problems might be an effect of adhering to a specific discourse. The typification of different discourses on consultations may function as a framework to help GPs reflect on how they perceive their practice, and help them manage some of the challenges met in daily practice.
Highlights
IntroductionSeveral principles that define ‘good consultations’ have been outlined
In medical literature, several principles that define ‘good consultations’ have been outlined
Discourses A detailed analysis of the General Practitioner (GP)’ narratives resulted in the identification of four discourses: a biomedically-centered discourse, a communication-focused discourse, a problemsolving discourse and a satisfaction-oriented discourse, each specified in terms of predominant themes, preferred problems and typical difficulties
Summary
Several principles that define ‘good consultations’ have been outlined. [8]) is vast in this respect These principles and guidelines are corroborated by research findings that depict the way medical practice can best take shape, and aim to prescribe practitioners’ actions and attitudes. Such a prescriptive approach is limited since it treats all individuals of a professional group, such as General. GPs differ in terms of their experience, capacity, personality and personal values [3,4,11,12] To further explore this subjective component, qualitative approaches that view GPs as “reflexive, meaning-making and intentional actors” (2003: 49) [13] and that identify patterns in the way they think and speak about their daily practice may be useful [10]. In this paper we adopt such qualitative stance, and view
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