Living with failing lungs: the doctor-patient relationship

The aim of the present study was to explore the perceptions and needs of chronic obstructive pulmonary disease (COPD) patients by a qualitative study using semi-structured interviews.

Sixteen patients with a diagnosis of COPD (age range 59-75 years) were recruited from two sample frames. One group were under the care of GPs and the second had received in-patient care previously at a district general hospital. Participants had either moderate or severe impairment of respiratory function identified by spirometric testing [forced expiratory volume in 1 second (FEV(1)) <50% of predicted value].

Primary and secondary care samples were chosen in the hope of identifying various aspects of care. However, the patients in this study primarily chose to discuss their relationship with their GP when considering aspects of their lives as a COPD patient. The most significant findings related to the respondents' chronic patient status, their ability to control symptoms and expectations of health care support. All these factors were connected to their perceived relationship with their GP.

Doctors, as gatekeepers of health care resources, were seen to have immense power over the patients' lives. The need to be perceived in a good light by their doctor was intensified by their low self-esteem, poor control of symptoms and their chronic disease status. The majority of patients expressed a need to take a more active part in the decision-making processes involved in the management of their disease. A more balanced doctor-patient relationship could develop if frank and open discussions are based upon a shared decision-making approach.