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J Med Ethics 37:650-654 doi:10.1136/jme.2010.041988
  • Clinical ethics
  • Paper

Courteous but not curious: how doctors' politeness masks their existential neglect. A qualitative study of video-recorded patient consultations

Open AccessEditor's Choice
  1. Åge Wifstad5
  1. 1Department of Research, Finnmark Hospital Trust, Hammerfest, Norway
  2. 2Institute of Clinical Medicine, University of Oslo, Oslo, Norway
  3. 3HØKH, Research Centre, Akershus University Hospital, Norway
  4. 4Centre for Medical Ethics, University of Oslo, Oslo, Norway
  5. 5Department of Community Medicine, Faculty of Health Sciences, University of Tromsø, Tromsø, Norway
  1. Correspondence to Kari Milch Agledahl, Department of Research, Finnmark Hospital Trust, Hammerfest 9616, Norway; kari.agledahl{at}helse-finnmark.no
  1. Contributors PG was responsible for the study in which the videotapes were collected, and collected some of the videotapes. KMA and ÅW developed the theoretical framework and designed the study. KMA analysed and interpreted all data and wrote the first draft of the manuscript. ÅW, PG and RF participated in the data analysis and interpretation. All authors reviewed and revised drafts of the manuscript and had full access to all data in the study. All authors made a final approval of the version submitted for publication. KMA is the guarantor.

  • Received 18 December 2010
  • Revised 11 April 2011
  • Accepted 14 April 2011
  • Published Online First 24 May 2011

Abstract

Objective To study how doctors care for their patients, both medically and as fellow humans, through observing their conduct in patient–doctor encounters.

Design Qualitative study in which 101 videotaped consultations were observed and analysed using a Grounded Theory approach, generating explanatory categories through a hermeneutical analysis of the taped consultations.

Setting A 500-bed general teaching hospital in Norway.

Participants 71 doctors working in clinical non-psychiatric departments and their patients.

Results The doctors were concerned about their patients' health and how their medical knowledge could be of service. This medical focus often over-rode other important aspects of the consultations, especially existential elements. The doctors actively directed the focus away from their patients' existential concerns onto medical facts and rarely addressed the personal aspects of a patient's condition, treating them in a biomechanical manner. At the same time, however, the doctors attended to their patients with courteousness, displaying a polite and friendly attitude and emphasising the relationship between them.

Conclusions The study suggests that the main failing of patient–doctor encounters is not a lack of courteous manners, but the moral offence patients experience when existential concerns are ignored. Improving doctors' social and communication skills cannot resolve this moral problem, which appears to be intrinsically bound to modern medical practice. Acknowledging this moral offence would, however, be the first step towards minimising the effects thereof.

Footnotes

  • Funding KMA received funding from Finnmark Hospital Trust (NO) and Northern Norway Regional Health Authority. South-Eastern Norway Regional Health Authority funded the study in which data were collected. The funding sources had no role in the design, data collection, data analysis, data interpretation, writing, or decision to submit the article for publication.

  • Competing interests None.

  • Ethics approval This study was conducted with the approval of the REK Sør-Øst C, Postboks 1130, Blindern, 0318 Oslo, Norway (Nr 2009/913). All patients and doctors provided written informed consent.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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