Melbourne Medical School Collected Works - Theses
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ItemWhen General Practitioners (GPs) and patients disagree: impact on the ethics and professional identity of GPs( 2023-04)Patients increasingly present to general practitioners (GPs) with already-formed views of what they feel they need (e.g. antibiotics, X-rays), but which the GPs consider unnecessary. This research explores how GPs experienced and managed these situations in clinical practice. Nineteen semi-structured individual interviews and two focus group interviews were conducted with practising GPs in Victoria, Australia. This study adopted a constructivist and interpretivist methodological approach, and investigated the GPs’ experiences and perspectives of these patient encounters without pre-supposition of what they ought to be doing or thinking. Study methodology privileged the participants’ accounts of their experiences, where they could raise issues that they, rather than the researcher, considered as important. Results showed that GPs found these patient requests for perceived unnecessary care challenging and stressful. They described these patient encounters in two main ways: as interpersonal disagreements with patients that they needed to manage, and also as ethical challenges where they had to work out the right thing to do. Further analysis elucidated that GPs experienced these ethical challenges as a threat that destabilised their professional identity of what it meant to be a good GP. GPs experienced the ethical challenge posed by these patient encounters not as an intellectual conundrum to be worked through dispassionate reasoning, but as a heartfelt threat to their professional identity as good GPs, and how they made sense of themselves and their work. For the GPs, managing these ethical challenges involved working on their sense of professional self, and trying to reshape this identity to mitigate the dissonance between their self-conception of a good GP and what patients expected them to do. My study showed that they struggled to do this work, which was effortful and emotionally stressful for them. This contributed to their sense of stress and distress in these patient encounters and helped explain why GPs found these perceived unnecessary requests so emotionally stressful and difficult. This study provides a fresh perspective on how ethical challenges are experienced and managed in clinical practice. The thesis describes how these patient encounters challenged the GPs’ identity conception of a good GP, the identity work they did in response, and their struggle with this identity work. The research highlights the need to consider the role of professional identity in ethical decision-making when examining ethics in primary care. Importantly, it suggests that effective ethics education and support for GPs require an identity-informed approach, where GPs can be supported to do the difficult and often emotionally stressful identity work. Effective ethics education and support for GPs will benefit not only GPs, but also the patients they care for. This study will also be of interest to medical educators and ethicists involved in the provision of ethics education and support.