The consultation between an individual patient and doctor is the bedrock of general medical practice. Varying perspectives on the nature and purpose of this interaction are apparent in the writings about the general practice consultation over the last half-century. The view of the consultation that underlies this study is that it is a social act whose nature and characteristics are determined in interaction between the doctor and patient and not by the activities of the doctor alone. The aim of this study is to explore how general practitioners experience satisfaction with their everyday consultations. Nineteen general practitioners took part in the study. They each audio-tape recorded between 25 and 30 consultations with consecutive consenting patients. They scored each consultation according to how satisfying they found it on a scale of 0-10, where 0 was maximally dissatisfying and 10 was maximally satisfying. A sample of six consultations from each doctor were chosen to include the most and least satisfying and these formed the basis of an in-depth qualitative interview between the doctor and myself. The data from the interviews was analysed using constant comparison to elucidate the doctors' views about their consultations and the reasons for consultations being satisfying or not. The empirical findings of this study reveal that the way doctors experience satisfaction in consultations relates to four broad issues. First their evaluation of their technical performance in the consultation, in particular their deployment of their clinical skills and their communication skills. Second the way they morally evaluate the patient and the purpose of this evaluation in the conduct of the consultation. Third the sense they have of knowing the patient which is seen to be qualitatively different from their knowledge about the patient. And finally the sense that the experience of the consultation is congruent with their knowledge of themselves as a doctor and thus is implicated in them maintaining a positive selfidentity. On the basis of these empirical findings a loose conceptual model of how general practitioners experience satisfaction in their work is proposed. The findings of the study are seen to have implications for the organisation and delivery of primary medical care, for the training of doctors and general practitioners and for the conduct of general practice research.
| Identifer | oai:union.ndltd.org:bl.uk/oai:ethos.bl.uk:726362 |
| Date | January 2003 |
| Creators | Fairhurst, Karen |
| Publisher | University of Edinburgh |
| Source Sets | Ethos UK |
| Detected Language | English |
| Type | Electronic Thesis or Dissertation |
| Source | http://hdl.handle.net/1842/24559 |
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