The voice of the self: a typology of general practitioners’ emotional responses to situational and contextual stressors

Abstract

Objective To develop a comprehensive typology of emotional reactions associated with stress among general practitioners (GPs), grounded in their own experiences. Design Data was generated using observations and unstructured interviews, using Straussian grounded theory as the overarching methodology. The typology was built using multidimensional property supplementation. Setting Eleven health care centres in urban and rural communities in four Swedish regions. Subjects Sixteen GPs and GP residents. Main outcome measures Characteristics of GPs’ emotional reactions in everyday work situations. Results Accounts of negative emotions connected to stress revealed four principal personal needs of the GP: trust, efficacy, understanding, and knowledge. Simultaneous threats to more than one of these needs invariably increased the level of tension. From these more complex accounts, six second-order needs could be identified: integrity, judgment, pursuit, authority, autonomy, and competence. The most extreme encounters, in which all four principal needs were threatened, were characterised by the experience of being reduced into an assistant. Conclusion The considerable resilience of GPs may belie some of the pressures that they are facing while being far from a fail-safe defence against being diverted from purposeful and morally responsible action. Our typology distinguishes between different forms of stress that may affect how GPs carry out their work, and connects to the vast literature on GP wellness. The results of this study could be used to develop tools for self-reflection with the aim of countering the effects of stress, and are potentially relevant to future research into its causes and consequences. Key points What is known •Stress among GPs may have severe consequences for themselves and their patients, and levels of stress appear to be increasing. What this article adds •Stressful situations threaten at least one of four principal needs of the GP: trust, efficacy, understanding, and knowledge. •More complex threats increase the level of tension and bring out second-order needs: integrity, judgment, pursuit, authority, autonomy, and competence. •The wealth of literature on GP stress can be clearly understood through the lens of our four-dimensional typology.

The voice of the profession: how the ethical demand is professionally refracted in the work of general practitioners

“…The GP is subject to a multitude of demands from several sources: the voice of the situation , which captures explicit demands voiced in the situation; the voice of the system , which lends support to some actions and discourages others; the voice of the self , which accounts for the stress that results from threats to the GP’s personal needs [ 21 ]; and the voice of the profession , which captures a professional moral view that does not depend directly on the situation or context.…”

“…By coding selectively around the highest-level concepts of the theory and simultaneously paying attention to the process, we eventually gained a deeper understanding of the circumstances that affect the moral actions of GPs. This led up to a second article in which we described the experience of stress—captured by the voice of the self —in general practice work, as well as the hypothesis that stress might guide the GP away from morally responsive action [ 21 ]. Although the voice of the profession is grounded in the same data as the previously mentioned concepts, we were able to elaborate on it only after coding selectively for it.…”

“…Although there are studies that describe substantively the morality of GPs in various situations, there have, to the best of our knowledge, been no attempts to integrate moral theory with empirical accounts of the embodied moral knowledge of GPs in order to inform a general normative theory of good general practice. In this article, we set out from our emerging theory of quality from the perspective of GPs [ 20 , 21 ] to investigate the professional morality of GPs, understood as one of four main drivers of their ethical decision-making: the voice of the situation, which carries the problem as presented by the other, as well as their express wishes; the voice of the system, which relates the demands of people who are not currently present; the voice of the self, concerned with survival and thriving in one’s work environment; and the voice of the profession, which is the focus of the present article. We approach this matter descriptively by theorising those experiences and reflections of GPs that pertain to professional morality.…”

Confidentiality matters! Adolescent males’ views of primary care in relation to psychosocial health: a structural equation modelling approach

“…As to the GPs role, our results suggest that developing a habit of offering private time and explaining professional secrecy would be beneficial. Considering the heavy workload that many GPs face [ 39 ], this might be perceived as an unrealistic task. One approach that might fit the bill, however, is a standardized split-visit model [ 1 , 40 ].…”

Roles of doctor–patient relationship perception and job satisfaction in the impact of workplace violence on medical professionals’ turnover intentions in the early phase of COVID-19: a cross-sectional study in China

“…Previous studies have often evaluated affective responses in relation to burnout. Recent studies have identified ‘trust, efficacy, understanding, and knowledge’ as four important personal needs that trigger negative emotional responses in physicians when they are threatened 29. Therefore, measuring medical professionals’ feelings of trust, recognition and respect may also help evaluate their emotional experiences.…”