Article Text
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.
- Applied and professional ethics
- philosophy of medicine
- professional—professional relationship
This is an open-access article distributed under the terms of the Creative Commons Attribution Non-commercial License, which permits use, distribution, and reproduction in any medium, provided the original work is properly cited, the use is non commercial and is otherwise in compliance with the license. See: http://creativecommons.org/licenses/by-nc/2.0/ and http://creativecommons.org/licenses/by-nc/2.0/legalcode.
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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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