The roles of healthcare professionals in diabetes care: a qualitative study in Norwegian general practice

Abstract

Objective: To explore the experiences of general practitioners (GPs), nurses and medical secretaries in providing multi-professional diabetes care and their perceptions of professional roles. Design, setting and subjects: Semi-structured interviews were conducted with six GPs, three nurses and two medical secretaries from five purposively sampled diabetes teams. Interviews were analysed thematically. Main outcome measures: Healthcare professionals' (HCPs') experiences of multi-professional diabetes care in general practice. Results: The involvement of nurses and medical secretaries (collaborating health care professionals) was mainly motivated by GPs' time pressure and their perception of diabetes care as easy to standardize. GPs reported that diabetes care had become more structured and continuous after the involvement of collaborating health care professionals (cHCPs). cHCPs defined their role differently from GPs, emphasizing that their approach included acknowledging patients' need for diabetes education, listening to their stories and meeting their need for emotional support. GPs appeared less involved in patients' emotional concerns and more focused on the biomedical aspects of illness. There was little emphasis on teamwork among GPs and cHCPs, and none of the practices used care plans to involve patients in decisions or unify treatment among professionals. Participants stated that institutional structures including a discriminatory remuneration system, lack of role descriptions and missing procedures for collaborative approaches were an obstacle to MPC. Conclusions: cHCPs worked independently under delegated leadership of the GPs. Although cHCPs had a complementary role, HCPs in general practice may not take full advantage of the potential of sharing patient responsibility and learning with, from and about each other. Contextual barriers for team-based care approaches should be addressed in future research.

Understanding care relationships in diabetes practice: A psychodynamic interview-based exploratory study

“…Indeed, diabetes care can progressively lead to burnout because of several care challenges involving frustration about patients’ nonadherence to recommendations and emotional fatigue about the redundancy of treatment topics [ 3 , 4 , 8 ]. In order to protect oneself, such overwhelming emotions are handled by focusing on more technical and biomedical aspects concerning the disease [ 29 ], seen as something separated from patients in line with the “phallocentric function” of medical intervention proposed by Fornari [ 20 ]. The use of mature defenses allows alleviating discomfort and anxiety, as found in other studies about healthcare professionals [ 18 , 30 ], as to reassure oneself and avoid feelings of powerlessness.…”

“…This in turn affects care relationships, potentially engendering feelings of guilt and inadequateness in physicians and consequently the urge to address patients’ needs [ 36 ]. Indeed, previous studies have found a strong perceived responsibility in dealing with the emotional sufferance of patients with diabetes [ 8 , 12 ] as well as a sense of deficiency and personal failure [ 9 , 35 ] that can be overcome by using active listening and relational skills [ 13 , 29 , 37 ]. In this sense, both the fear of failure and the strive for achievement are strongly intertwined and underlie a motivation to derive satisfaction from the mastery of challenging tasks and effective care relationships [ 38 ].…”

“…This may lead to feeling overwhelmed by social needs of patients as well as confused about one’s professional role because of the risk of an excessively symbiotic relation with patients [ 8 ]. As a consequence, physicians strive to maintain professional boundaries and try to get less involved in patients’ emotional concerns [ 29 ], for instance adopting an assertive attitude and paternalistic communication with patients within an asymmetrical relationship [ 8 ].…”

Sexual history taking: Doctors’ clinical decision-making in primary care in the North West province, South Africa

“…2,56 Best interest should also imply giving attention to holistic well-being, although it has been shown that patients' preferences and subjective illness experiences are often not a consideration in clinical judgement or decision-making. 19,57,58,59 It seems sexual history taking in practice is not core to the decision-making process in the management of patients with chronic disease despite being a theoretical and health priority.…”

Experiences of self-management support in patients with diabetes and multimorbidity: a qualitative study in Norwegian general practice

“…As such, these cHCPs worked in parallel with the GPs, who were only consulted when needed. All cHCPs reported to have training in diabetes care and in patient-centred or motivational communication skills (cHCPs' experiences of team-based diabetes care from the same practices are reported in another publication; Sørensen et al, 2020). Table 1 shows the total number of GPs in the included practices, whether they were urban or rural and whether a nurse or a medical secretary was involved in the provision of diabetes care.…”