Recovering general practice from epistemic disadvantage

Hull, Sally; Hull, George

doi:10.4324/9781315277073-1

Cited by 4 publications

(3 citation statements)

References 1 publication

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“…While the current study demonstrates that GPs also relate to these patients in ways that are not based on the biomedical model, it also shows it can be challenging for GPs to mobilize these ways of engaging with patients, and the GPs in our study found it hard to articulate their experiences in this regard. The difficulties in identifying patients’ strengths that the GPs in our study experienced can be seen as a case of the epistemic disadvantage of generalist expertise [ 47 ], i.e. difficulties in integrating their relation to the patient as a person into the GPs’ understanding of their professional role due to the privileged position of biomedical knowledge.…”

Section: Discussionmentioning

confidence: 99%

Discovering strengths in patients with medically unexplained symptoms – a focus group study with general practitioners

Jøssang

Aamland

Hjörleifsson

2022

Scandinavian Journal of Primary Health Care

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Background When patients suffer medically unexplained symptoms, consultations can be difficult and frustrating for both patient and GP. Acknowledging the patient as a co-subject can be particularly important when the symptoms remain unexplained. One way of seeing the patient as a co-subject is by recognizing any among their strong sides. Objectives To explore GPs’ experiences with discovering strengths in their patients with medically unexplained symptoms and elicit GPs’ reflections on how this might be useful. Methods Four focus-groups with 17 GPs in Norway. Verbatim transcripts from the interviews were analyzed by systematic text condensation. Results Recollecting patients’ strengths was quiet challenging to the GPs. Gradually they nevertheless shared a range of examples, and many participants had experienced that knowing patients’ strong sides could make consultations less demanding, and sometimes enable the GP to provide better help. Identifying strengths in patients with unexplained symptoms required a deliberate effort on the GPs’ behalf, and this seemed to be a result of a strong focus on biomedical disease and loss of function. Conclusions Acknowledging patients’ strong sides can bolster GPs’ ability to help patients with medically unexplained symptoms. However, the epistemic disadvantage of generalist expertise makes this hard to achieve. It is difficult for GPs to integrate person-centered perspectives with biomedical knowledge due to the privileged position of the latter. This seems to indicate a need for system-level innovations to increase the status of person-centered clinical work. Key points MUS is challenging for both patients and GPs mainly because of the incongruence between symptoms and the dominating biomedical model. GPs’ focus on pathology and loss of function can prevent them from discovering patients’ strengths. Awareness of patients’ strengths can make consultations less demanding for GPs and enable them to provide better help. A conscious effort is needed to discover patients’ strengths.

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Section: Discussionmentioning

confidence: 99%

Discovering strengths in patients with medically unexplained symptoms – a focus group study with general practitioners

Jøssang

Aamland

Hjörleifsson

2022

Scandinavian Journal of Primary Health Care

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“…Compounding the issue of the limited recognition of generalist knowledge work is the already denounced marginalisation of general practice compared to other specialties, and the discrediting of GPs' knowledge in their interactions with other medical professionals (40). In this context, recognising the skills and knowledge of GPs is crucial to advance of primary care, as systemic change relies on bottom-up initiatives that target areas of tension within established systems (41).…”

Section: Comparison With Existing Literaturementioning

confidence: 99%

Addressing hidden tensions and grey areas of general practice: a qualitative study of the experiences of newly qualified GPs attending a course on generalist medicine

Dell’Olio,

Reeve

2024

Br J Gen Pract

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Background Generalist approaches can help address several challenges facing today’s primary care. However, GPs report insufficient support to deliver advanced generalist medicine (AGM) in daily practice, struggling within a healthcare system that imposes strict adherence to single-disease focused guidelines. Aim We aimed to examine the professional and educational experiences of newly qualified GPs attending a course on AGM to understand how to redesign primary care systems to support their generalist work. Design and Setting Qualitative study focusing on AGM in UK general practice (England), conducted in the context of the research evaluation of an online career development programme on AGM. Method We conducted 36 interviews and 6 focus groups with newly qualified GPs attending an online career development programme on AGM, and analysed data using framework analysis. Results Three tensions experienced by the participants were identified: tension between realistic and idealistic practice; tension between different decision-making paradigms; tension in the formation of the GPs’ professional identities. These were due to grey areas of practice deeply rooted in primary care systems – namely areas of work not adequately addressed by current education and service design. Conclusions Our findings have implications for tackling the general practice workforce crisis, highlighting that solutions targeting individual problems will not suffice by themselves. By making visible the grey areas of everyday general practice, we describe the changes needed to target tensions as described by the GPs in this study to ultimately enable, enhance and make visible the complex work of generalist medicine.

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“…These two narratives illustrate epistemic injustice -wrong done to someone specifically in their capacity as knower, a phenomenon that is all too common in medical practice, whereby a patient suffers an unfair credibility deficit, by virtue of being a patient. 12,13 Creative texts can surface and make visible concepts such as epistemic injustice that might otherwise remain 'inarticulate' in the professional culture of practice.…”

Section: The Patient's Testimonymentioning

confidence: 99%

Creative enquiry and the clinical encounter

Younie

Swinglehurst

2019

Br J Gen Pract

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Creative enquiry and the clinical encounterLife & Times 'Across the bay I heard the surgeon ask about the decorative button sewn delicately onto a night gown allowing access to the wound where a breast once was. He tried to garner interest from the anaesthetist in the family story of the button's creation. I breathed in the humanity as I waited for him to come round to me with news of my op.' (Louise Younie, cancer experience reflection, 2019

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Recovering general practice from epistemic disadvantage

Cited by 4 publications

References 1 publication

Discovering strengths in patients with medically unexplained symptoms – a focus group study with general practitioners

Discovering strengths in patients with medically unexplained symptoms – a focus group study with general practitioners

Addressing hidden tensions and grey areas of general practice: a qualitative study of the experiences of newly qualified GPs attending a course on generalist medicine

Creative enquiry and the clinical encounter

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