Personal responsibility for health? A phenomenographic analysis of general practitioners’ conceptions

Abstract

Objective: To analyse and describe general practitioners' perceptions of the notion of a 'personal responsibility for health'. Design: Interview study, phenomenographic analysis. Setting: Swedish primary health care. Subjects: General Practitioners (GPs). Main outcome measures: Using the phenomenographic method, the different views of the phenomenon (here: personal responsibility for health) were presented in an outcome space to illustrate the range of perceptions. Results: The participants found the notion of personal responsibility for health relevant to their practice. There was a wide range of perceptions regarding the origins of this responsibility, which was seen as coming from within yourself; from your relationships to specific others; and/ or from your relationship with the generalized other. Furthermore, the expressions of this responsibility were perceived as including owning your health problem; not offloading all responsibility onto the GP; taking active measures to keep and improve health; and/or accepting help in health. The GP was described as playing a key role in shaping and defining the patient's responsibility for his/her health. Some aspects of personal responsibility for health roused strong emotions in the participants, especially situations where the patient was seen as offloading all responsibility onto the GP. Conclusion:The notion of personal responsibility for health is relevant to GPs. However, it is open to a broad range of interpretations and modulated by the patient-physician interaction. This may make it unsuitable for usage in health care priority settings. More research is mandated to further investigate how physicians work with patient responsibility, and how this affects the patient-physician relationship and the physician's own well-being. KEY POINTSThe notion of personal responsibility for health has relevance for discussions about priority setting and person-centred care. This study, using a phenomenographic approach, investigated the views of Swedish GPs about the notion of personal responsibility for health. The participants found the notion relevant to their practice. They expressed a broad range of views of what a personal responsibility for health entails and how it arises. The GP was described as playing a key role in shaping and defining the patient's responsibilities for his/ her health. The notion was emotionally charged to the participants, and when patients were seen as offloading all responsibility onto the GP this gave rise to frustration.

The role of patients in the governance of a sustainable healthcare system: A scoping review

“…Studies indicated that individuals are accountable for lifestyle choices and risks that could have been avoided [ 33 , 34 , 37 – 39 , 41 – 43 , 47 , 48 , 56 ], attempting to make the best choices for their health [ 33 , 35 , 52 , 56 ] and implementing health promotion and healthy living and safe activities [ 49 , 51 ]. A study highlighted patient responsibilities, which included being truthful, providing a complete medical history, requesting information or clarification, complying with physician instructions, meeting financial obligations, being cognizant of the costs associated with healthcare, using medical resources judiciously and discussing the end of life decisions and organ donation [ 54 ].…”

“…This highlights the importance of individualized care or patient-oriented care [ 49 ]. Thus, patients should be willing to accept help for their care while also keeping in mind that their health is under their control instead of completely shifting their roles onto their healthcare providers [ 56 ].…”

“…These studies acknowledged that a shared model of accountability between patients and their healthcare providers, and between patients and their communities/society were the preferred and fairer models [ 34 , 37 , 38 , 40 , 46 – 48 , 50 , 51 , 54 , 59 ]. In addition, recognizing and integrating the origins of responsibility, (which include personal maturity, civic duties, respect for autonomy, and relational duties to loved ones and physicians), to these approaches are essential [ 56 ].…”

Safety and Proven Risk Assessment on the Release of Wolbachia-Inserted Aedes Aegypti: Lesson Learned from the Partial Resistance of the Community

“…Positive ideas like free choice and personal responsibility unfortunately may harm health and well-being [27]. Certainly, such statements can be positive and empowering 28].…”

Exploring what is reasonable: uncovering moral reasoning of vascular surgeons in daily practice

“…However, trying to uncover how health care professionals deal with ethical issues is methodologically complex, partly because the term ‘ethical issues’ lacks a clear definition [ 8 – 10 ]. Literature in ethics further displays broad and varied concepts aiming to capture dealing with ethical issues ranging from considerations [ 11 ], perspectives [ 12 , 13 ], views [ 14 , 15 ], conceptions [ 16 ], moral values [ 17 ], ethical reasoning [ 18 , 19 ], justifications [ 20 ], and decision-making [ 21 , 22 ]. Even if there are considerable differences between these concepts, they also point to the intricate methodological problems of trying to capture the dealing with ethical issues in the clinical context of patients and clinicians.…”