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Related Experiment Video

Updated: Jan 2, 2026

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Subjunctive medicine: Enacting efficacy in general practice.

Doug Hardman1, Adam W A Geraghty2, Mark Lown2

  • 1Bournemouth University, United Kingdom.

Social Science & Medicine (1982)
|November 30, 2019
PubMed
Summary
This summary is machine-generated.

General practice is complex, requiring clinicians to balance medical science with patient values for person-centred care. A study found clinicians developed "good habits" and "enaction" to manage constraints and foster collaborative consultations.

Keywords:
EnactivismEnglandEthnographyGeneral practiceGrounded theoryPerson-centred care

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Area of Science:

  • General Practice
  • Medical Sociology
  • Qualitative Research

Background:

  • Modern general practice faces complexity due to multimorbidity, polypharmacy, and chronic illness.
  • Evidence-based guidelines for single conditions are difficult to apply to multifaceted patient needs.
  • General practice requires integrated clinical and social solutions, necessitating person-centred care.

Purpose of the Study:

  • To explore how general practice clinicians navigate complex patient needs and implement person-centred care.
  • To identify strategies used by clinicians to overcome constraints in general practice.
  • To propose a new framework for medical practice, 'subjunctive medicine', to enhance person-centred care.

Main Methods:

  • Ethnographic study of an English general practice surgery.
  • Involved participant observation, interviews, and focus groups with patients, clinicians, and staff.
  • Data collected from February 2018 to March 2019.

Main Results:

  • Clinicians faced constraints from biomedical limitations and structural issues within general practice.
  • They mitigated challenges through "good habits": expert judgment and taking patients seriously.
  • Clinicians developed a "meta habit" of "enaction," treating each consultation as a unique, collaborative creation.

Conclusions:

  • General practice consultations are co-created, operating in both indicative and subjunctive moods.
  • Proposes 'subjunctive medicine' as a framework valuing the collaborative nature of general practice consultations.
  • Suggests subjunctive medicine can help clinicians achieve person-centred care sustainably and resiliently.