‘I deal with the small things’: The doctor–patient relationship and professional identity in GPs’ stories of cancer care

Abstract

An important part of GPs' work consists of attending to the everyday and existential conditions of human being. In these life world aspects, biomedicine is often not the relevant theory to guide the GP; nevertheless they are a part of GPs' professional domain. In cancer care, previous studies have shown that GPs with a biomedical perspective on medicine could feel subordinate to specialists, and that doctors with a curative focus could see disease progression as a personal failure. The aim of this study was to explore in depth the experiences of being a GP for people with advanced cancer. Fourteen Norwegian GPs were interviewed about accompanying patients through a cancer illness. Their stories were analysed using a narrative approach. The GPs expressed a strong commitment to these patients, a loyalty which in some cases could be weakened due to judgements of distant specialists. In view of the GPs' close knowledge of their patients' background and history this subordination was a paradox, mirroring a hierarchy of medical knowledge. The GPs had an ideal of honesty and openness about death, which they sometimes failed. To reach the ideal of honesty, clinicians would have to abandon the biomedical ideal of mastering human nature through interventions and acknowledge the fundamental uncertainty and finiteness of human life. GPs may learn from being with their patients that bodily and existential suffering are connected, and thus learn implicitly to overlook the body-mind dualism. This practical wisdom lacks a theoretical anchoring, which is a problem not only for general practice.

The sociology of cancer: a decade of research

“…) and their interactions with care‐givers, stressing the social processes that shape decision‐making, disclosure and interpretation of results (Gross , Johansen et al . , , Sarradon‐Eck et al . ; Stacey et al .…”

“…Articles on patient-caregiver interactions and service uptake were primarily focused on understanding and improving or supporting patients' understandings of risk and responsibility (Heyman et al 2012, Mendick et al 2010, Sinding et al 2010 and their interactions with care-givers, stressing the social processes that shape decision-making, disclosure and interpretation of results (Gross 2012, Johansen et al 2012, Sarradon-Eck et al 2012Stacey et al 2009). These included decision-making beyond treatment, fertility preservation (Quinn et al 2008) and participation in early-stage trials (Jansen 2014).…”

Searching for wisdom in oncology care: A scoping review

“…Four articles suggested that wisdom emerges within practitioners' practice experience as cancer care providers (Cueva, 2011; Johansen et al, 2012; Jordens & Little, 2004; O'Callaghan, 2005). Wisdom is often termed in this context as “practical wisdom” or “practice wisdom.” Jordens and Little (2004) utilized narrative inquiry and genre theory to study ethical reasoning from interviews with clinicians treating colorectal cancer.…”

“…Johansen and colleagues (2012) offer some perspective on “practical wisdom” and its tensions in the clinical practices of general practitioners (GPs) in oncology care. They used a thematic narrative approach in a study with 14 GPs in Norway.…”

“…"Practice wisdom" as derived from practitioners' lived experience(s). Four articles suggested that wisdom emerges within practitioners' practice experience as cancer care providers (Cueva, 2011;Johansen et al, 2012;Jordens & Little, 2004;O'Callaghan, 2005). Wisdom is often termed in this context as "practical wisdom" or "practice wisdom."…”