Relational competence and emotions among general practitioners when managing complex patients: a qualitative study

Relational competence is relevant in all relationships, but in institutional relationships there are goals to achieve, which shape the competence. 'Teacher's Relational Competence' is conceptualized as conducive to achieving the institutional goal within the profession. In the doctor-patient relationship, the institutional goals and conditions for the relation, although different, might benefit of a similar approach to conceptualizing the relational competence within the profession. The purpose of this study is to use Teacher's Relational Competence as inspiration to conceptualize General Practitioner's Relational Competence and to explore how emotions play a role.

Nine general practitioners (GPs) were interviewed using video-stimulated recall with a recording of an extended consultation for complex patients. The interviews were analyzed using abductive analysis.

We found two categorizations for how the GPs aimed for institutional goals. 'Relational prioritization' and 'Non-relational prioritization'. Relational prioritization refers to how GPs used the relationship to aim for goals. This could be performed as 'Open navigation', when patients presented several health concerns, or 'Curious retrieval', when patients did not introduce anything to discuss related to their health complexity. In both strategies, GPs had a balanced emotional representation of both Frustration and Satisfaction. Non-relational prioritization was used by GPs, who had preconceived ideas on goals where the patient and their relationship did not affect the GP's goal assessment. This could be performed as 'Refrain', when GPs distanced themselves from the patients' decisions, or as 'Regulation', where GPs were adamant to the preconceived goal without being affected by the patient. GPs who performed 'Refrain' demonstrated no emotional representation, neither Satisfaction nor Frustration, and GPs who performed 'Regulation' exhibited an intense representation of Frustration, thus both having an unbalanced emotional representation.

The study concludes that relational prioritization could be part of a conceptualization of relational competence for GPs.