General Practitioners Caught in the "Trap of a Relationship"? Results of a Qualitative Study about Concepts of Disease Held by Doctors and Their Treatment Strategies of Venous Ulcer

Abstract

In general practice, how patients and doctors conceptualize disease plays an important part in decision making and in the patient-doctor relationship. Although the concepts of disease held by patients have been extensively investigated there is little empirical research about doctors’ concepts of disease. To explore more closely doctors' concepts of disease we investigated general practitioners' (GP) conceptualization of venous ulcer as an example. For this purpose we performed a secondary analysis of narrative interviews in which general practitioners were interviewed by fellow doctors or senior medical students about their patients with venous ulcers. Text analytic and interpretative techniques were used, leaning partly on the methodology of Grounded Theory. Interpretations and structural hypotheses about the hidden concepts of disease found within single cases or the comparison of all cases will be discussed in this article. Surprisingly, doctors' concepts of disease in relation to venous ulcer are not based primarily on medical knowledge. In addition to cognitive aspects, the concepts of disease reveal dimensions of emotionality and interaction, which have rarely been investigated. For example venous ulcers are looked upon as a familiar and easily treatable; whereas the patients themselves are seen as an unpleasant factor of interference. The doctors seem to feel more irritated while speaking about the interaction with the patient than the medical knowledge itself. Our research about general practitioners' concepts of disease in relation to venous ulcers reveals that social phenomena such as processes of perception, interpretation, and understanding are more important than medical knowledge of the disease. URN: urn:nbn:de:0114-fqs0801420