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Chronic unhappiness. Investigating the phenomenon in family practice
1Department of Family Medicine, Medical University of Southern Africa.
Purpose:
To investigate the experience of chronic unhappiness as it presents in family practice.
Design:
A descriptive, qualitative study of both patients and physicians using an existential phenomenologic approach.
Setting:
Two village general practices in South Africa.
Participants:
Four patients who were difficult, "heartsink" patients, who gave their doctors an overwhelming feeling of exasperation and defeat.
Method:
We investigated the clinical records thoroughly and explored patients' relationships with others. Through interpretation and reflection, we tried to discover what role the doctor could play with these patients.
Findings:
Chronic unhappiness was found to be not only a condition of life for the patients but also for the doctor. It was an important factor in the relationship they shared. Unhappiness was revealed in part by frequent visits by the patients, a constellation of negative feelings in the doctor, and difficult patient-doctor relationships.
Conclusion:
Chronic unhappiness is not "treatable" in the normal curative or therapeutic sense. This does not prevent our quest to diagnose and cure, but enlarges our horizons to recognizing and accepting our own human reactions to patients and understanding how we can meet their needs.