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24-10-2011 | Article

Doctors are courteous, but lack ‘existential’ care


Free abstract

MedWire News: Hospital doctors display courteousness to their patients, but show little regard for the personal implications of patients' conditions, their concerns, worries, and fears, show Norwegian study results.

Courteousness may improve the doctor-patient relationship, say the researchers, and a certain amount of ignoring personal narratives may help physicians apply their scientific knowledge; however, it also risks missing important clinical information.

Kari Agledahl (Finnmark Hospital Trust, Hammerfest) and colleagues remark: "It is uncertain whether it is possible for doctors to care for patients existentially while also attending to their clinical responsibilities which requires them to apply a depersonalised medical science."

However, acknowledging this "moral offence," they say, would contribute towards minimizing its effects.

The researchers studied how doctors' care for their patients is reflected in their conduct by analyzing 380 videotaped encounters in a 500-bed general teaching hospital in Norway. The encounters included 71 doctors working in clinical, nonpsychiatric departments.

Videos were examined by a junior doctor, a philosopher, a professor of philosophy, an experienced general practitioner and professor of medical ethics, and an experienced general practitioner and professor of health services research with expertise in clinical communication.

Three types of interpretation emerged, found the research team; doctors' medical concern, their courteousness, and their existential care.

The team reports three scenarios in the Journal of Medical Ethics, to illustrate their findings.

One male pulmonary patient raises the topic of his deceased wife, which the doctor ignores, despite the patient explaining that his health problems had increased since she died, and the physician expressly saying she has plenty of time.

Indeed, instead of addressing this "existential aspect," write Agledahl et al, the doctor quickly changes the subject with a medically focused question about smoking.

In another encounter, involving a 60-year old man with metastasizing cancer, the doctor's strong medical concerns guide the entire conversation, overshadowing concerns expressed by the patient and his wife, despite the fact that all treatment is palliative, not curative.

Specifically, when the patient raises the issue of his decreasing energy levels, the doctor asks him to quantify his daily activity levels. By the end of the appointment, the patient delays leaving the consultation, which Agledahl and co-workers believe is due to his fears remaining unaddressed.

The regularity of doctors' lack of existential care should not be considered an example of "bad medical practice," write the researchers, but as part of "ordinary interactions" that represent "medical processing."

However: "Doctors should be familiar with the negative effects of their professional care, even if they are unavoidable.

"When doctors are unable to follow-up on a patient's personal perspective, they should be aware of the moral harm caused by this rejection," they conclude.

By Sarah Guy