A doctor close at hand : a qualitative analysis of GPs' work in cancer care

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A doctor close at hand : a qualitative analysis of GPs' work in cancer care

 

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Title: A doctor close at hand : a qualitative analysis of GPs' work in cancer care
Author: Johansen, May-Lill
Date: 31-Aug-2012
Type: Doctoral thesis; Doktorgradsavhandling
Abstract: Summary of thesis The core of medicine, even specialized and high-tech medicine, is a meeting, a consultation, between a human being asking for advice and another human being, whose knowledge and experience is expected to be helpful. This thesis explores how the suspicion of cancer can arise in such a consultation, how general practitioners (GPs) can contribute to cancer care and how GPs might accompany people with cancer towards the end of life. 25 qualitative interviews with Norwegian GPs about diagnosing and attending people with cancer through the course of illness were analyzed. Besides clinical assessments and paperwork, the GPs often acted as intermediaries between the patient and the hospital. They pushed for quick hospital appointments, interpreted and translated discharge letters and were asked for second opinions. In rural areas some GPs offered cytostatic treatments. Knowing the patient and preferably also the family was seen as a premise for being a good GP. In the researcher’s interpretation, the GPs were well acquainted both with the patients’ world and with the clinical world. They could act as guides for their patients, but their personal knowledge of patients could, even if it was clinically relevant, be given less weight when confronted with hospital routines and criteria. This could lead to conflicting loyalties for the GPs. During end-of-life care in the patients’ homes, existential conversations were seen as demanding but rewarding. Palliation of pain was an easy task compared to being a fellow human being, listening and attempting to comfort a person who is afraid to die. Norsk sammendrag Avhandlingen tar utgangspunkt i at kjernen i medisin, selv i spesialisert og høyteknologisk medisin, er et møte mellom mennesker: Et som søker råd og et annet som har nødvendig kunnskap og erfaring. Avhandlingen undersøker hvordan mistanken om kreft kan oppstå i et slikt møte, hva fastleger kan bidra når folk får kreft og hvilke utfordringer de ser når de følger noen med langkommet kreft mot livets slutt. Forskeren analyserte i alt 25 kvalitative intervju med norske allmennleger. De fortalte om pasienter de hadde fulgt gjennom et sykdomsforløp. Ved siden av kliniske vurderinger og papirarbeid var de ofte formidlere mellom pasienten og sykehuset. De ble spurt om behandlingsråd, tolket og oversatte brev fra sykehuset, og var pådrivere for kortere ventetid. I distrikt ga noen også cellegiftkurer. Det å kjenne pasienten og gjerne også familien ble sett på som en forutsetning for å være en god lege. Forskeren oppfattet allmennlegene som lokalkjente både i pasientens verden og i den kliniske verden. Dette var en styrke overfor pasientene, men i forhold til sykehuset kunne fastlegens nærkunnskap bli oppfattet som mindre viktig enn systemets rutiner og kriterier. Det kunne føre til lojalitetskonflikter for allmennlegene. I omsorgen hjemme hos pasienten ved livets slutt var eksistensielle spørsmål både krevende og givende. Å lindre smerter var enklere enn å være et lyttende og trøstende medmenneske for en som fryktet døden.
Description: The papers of this thesis are not available in Munin: Johansen, M.-L., Holtedahl, K. A., & Rudebeck, C. E.: 'A doctor close at hand : how GPs view their role in cancer care', Scandinavian Journal of Primary Health Care (2010) vol. 28(4): 249-255. Available at http://dx.doi.org/10.3109/02813432.2010.526792
2. Johansen, M.-L., Holtedahl, K.A., Davidsen, A.S & Rudebeck, C.E.: 'I deal with the small things : the doctor-patient relationship and professional identity in GPs’ stories of cancer care', Health, November 2012, vol. 16 no. 6. Available at http://dx.doi.org/10.1177/1363459312438565
3. Johansen, M.-L., Holtedahl, K.A., & Rudebeck, C.E.: 'How does the thought of cancer arise during a consultation in general practice?' Accepted manuscript. Published version in Scandinavian Journal of Primary Health Care, September 2012, Vol. 30, No. 3, is available at http://dx.doi.org/10.3109%2F02813432.2012.688701
Publisher: University of Tromsø; Universitetet i Tromsø
Series: ISM skriftserie, nr 127
URI: http://hdl.handle.net/10037/4381


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