Patient-doctor relationships between same-sex attracted women and general practitioners (GPs) have been presented as problematic in the literature. The problems arise from women’s concerns about the potential for negative attitudes amongst GPs. They also relate to GPs’ concerns about offending patients if they ask about sexual orientation due to the stigmatised nature of minority sexual orientation. As a result, disclosure of sexual orientation can be difficult and the patient-doctor relationship can be compromised. The aim of this study was to explore the nature of patient-doctor relationships in this context and how optimal relationships can be achieved. / Using a critical hermeneutic approach, I conducted in-depth interviews with 33 same-sex attracted women and 28 doctors. This included 24 pairs of people in a current patient-doctor relationship. I found that women commonly experienced silencing of their minority sexual orientation within general practice settings, but that this was occasionally desired and not problematic for some women and most GPs. For other women and for many GPs, the silence resulting from a lack of disclosure was a response to perceived risks to women’s personal identity and GPs’ professional identity. Few GPs asked directly about sexual orientation, placing the burden of responsibility for disclosure on same-sex attracted women. Building reciprocal trust could overcome the perceived risks inherent in revealing minority sexual orientation. I initially defined optimal patient-doctor relationships in terms of existing models of cultural competence and patient-centredness; however I found that such relationships were built on cultural sensitivity rather than cultural competence, and relationship-centredness rather than patient-centredness. / I developed a new model of sexual identity disclosure that demonstrated the key influences on disclosure of sexual orientation to GPs for same-sex attracted women. These influences were women’s sexual identity experience, risk perceptions, and the level of knowing within the patient-doctor relationship. The model depicts women’s range and fluidity of sexual identity experiences and challenges current assumptions that disclosure is essential for effective health care. The model has transformative potential for general practice education and research. It could assist GPs to understand that not all women desire disclosure, but that the majority of women are happy to disclose if asked. GPs would be encouraged to take note of the socio-political environment in which women live and its influence on women’s fears and actual experiences of discrimination. Finally, understanding the role of trust and reciprocal knowing in mitigating perceived risks would encourage GPs to focus more on relationship building. This could also assist GPs to overcome their own perceptions of risk and encourage them to broach the subject of sexual orientation, ultimately enhancing the patient-doctor relationship.

Project (Ed.S.)--James Madison University, 2009. / Includes bibliographical references.

Background: The implementation of the Care Matters: Transforming the Lives of Children and Young People in Care Green Paper (Department for Education and Skills, (DfES) 2006) and the subsequent Care Matters: Time for Change White Paper (DfES, 2007), witnessed the consolidation of a universal ambition to improve the opportunities for all children living in care. Arguably, the most important recommendation in this pursuit is reflected in the need to provide people who have lived in care as children with independent support, which enables them to discuss their experiences, and suggest ways in which the care system might be improved. However, whilst this recommendation has been implemented with a diverse range of care leavers, the impact of the experience of living in care and the associated disadvantage experienced by Travellers and Gypsies remains under researched, understated, and unacknowledged (Cemlyn et al., 2009). Methodology: Guided by the philosophical assumptions of interpretative phenomenological analysis (IPA), this study represents and constructs the experience of living in public care by focusing on the voices 10 Travellers and Gypsies who lived in care as children. Testimonies were collected through a wide variety of methods that included face-to-face interviews, focus groups, telephone interviews, blogs, emails, letters, song lyrics, and poems. Findings: Following a considered application of IPA, six main themes emerged from the analysis. These were social intervention; an emotional rollercoaster of separation, transition, and reincorporation; a war against becoming settled; leaving care and the changing relationship with the self and others; inclusion and strength; and, messages for children living in care. In line with the tenets of phenomenology, these findings are presented in such a way to as to invite the reader to move away from their own personal understanding of the world in order to enter the ‘lifeworld’ (Husserl, 1970, 1982) of Travellers and Gypsies who lived in care as children. However, to assist in this sense making activity, this study also provides a discrete interpretation of the findings before developing this knowledge to form a more detailed theoretical construct entitled ‘the model of reflective self-concepts’. Taken together with the testimonies of each person who took part in the study, the thesis enables an understanding of how the experience of living in care is inextricably linked to a process of social and psychological acculturation. By staying close to the experiences provided, it reveals how a process of change is determined, more often than not, by a sense of personal resilience directly related towards a Traveller or Gypsy self-concept. In attempt to move towards service improvement, this thesis offers a series of recommendations and conclusions which aim to support social workers and carers empower Traveller and Gypsy children to develop a secure Traveller and Gypsy self-concept thus enabling them experience improved outcomes including those opportunities set out in Care Matters social policy agenda (DfES, 2006; 2007).