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Using Visual and Narrative Methods to Achieve Fair Process in Clinical Care
Published on: February 16, 2011
Doctors, "dirty work" patients, and "revolving doors"
1Centre for Research in Medical Sociology and Health Policy, University of Nottingham, United Kingdom.
Abstract:
Using information from research into the phenomenon of "revolving-door" psychiatric patients, the author explores general practitioners' perceptions of difficult patients and the consequences for patient management. He first considers the concept of "good and bad" as a possible subtype of dirty work. He then presents the evidence of medical irritation with patients from interview data and explores the rationalizations for the way in which patients are subsequently managed. In line with previous studies, the author argues that the construction of patients as difficult and the subsequent dynamics of exclusion lie in the breakdown of the "normal" doctor-patient relationship coupled with the doctor's need to get on with the day's workload. Moral judgments formed a part of the exclusion process.
Insights
General practitioners often perceive certain patients as "difficult," leading to management challenges and exclusion. This perception stems from disrupted doctor-patient relationships and workload pressures, influenced by moral judgments.
Area of Science:
- Psychiatry
- General Practice
- Sociology of Medicine
Background:
- The
Purpose of the Study:
- To explore general practitioners' (GPs) perceptions of difficult patients.
- To understand the consequences of these perceptions for patient management.
- To examine the role of "good and bad" concepts and "dirty work" in GP-patient interactions.
Main Methods:
- Qualitative analysis of interview data from general practitioners.
- Exploration of GPs' rationalizations for patient management strategies.
Main Results:
- GPs' perceptions of patients as "difficult" are linked to the breakdown of the "normal" doctor-patient relationship.
- Medical irritation and moral judgments contribute to patient exclusion.
- Workload pressures and the need to maintain daily workflow influence management decisions.
Conclusions:
- The construction of patients as "difficult" is a dynamic process influenced by relational and systemic factors.
- Exclusionary practices in patient management are rationalized by GPs.
- Understanding these dynamics is crucial for improving care for patients with complex needs, including "revolving-door" psychiatric patients.
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