‘We are the barriers’: Danish general practitioners’ interpretations of why the existential and spiritual dimensions are neglected in patient care
DOI:
https://doi.org/10.1558/cam.32147Keywords:
biopsychosocial-existential, general practice, physician-patient communication, spiritualAbstract
Although it is broadly recognized that health problems often involve existential and spiritual dimensions, recent research shows that these aspects of illness are rarely attended to by health professionals. Studies explain this in terms of barriers to communication, but health professionals’ firsthand experiences and interpretations have so far been largely unexplored. Drawing on the theoretical traditions of phenomenology and hermeneutics, the present study presents Danish general practitioners’ (GPs’) experiences and interpretations of why the existential and spiritual dimensions are marginalized in patient care. We conducted seven focus groups, constituting a total sample of 31 GPs. Based on the analytic strategy of Interpretative Phenomenological Analysis (IPA), our analysis revealed that the GPs experienced and interpreted individual barriers as created and fostered within dominant biomedical and secular cultures that are characterized as ‘solution focused’ and ‘faith frightened’. Many GPs further understand themselves as barriers, because they are enculturated into these dominating cultures. We discuss these findings through theoretical concepts such as ‘secondary socialization’, ‘system colonization’ and ‘secularization’, and suggest interventions that might challenge current practice culture.References
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Andersen, R. S. and Vedsted, P. (2015) Juggling efficiency: An ethnographic study exploring healthcare seeking practices and institutional logics in Danish primary care settings. Social Science & Medicine 128: 239–245. https://doi.org/10.1016/j.socscimed.2015.01.037
Assing Hvidt, E., Iversen, H. R. and Hansen, H. P. (2012) Belief and meaning orientations among Danish cancer patients in rehabilitation: A Taylorian perspective. Spiritual Care 1 (3): 1–22.
Assing Hvidt, E., Iversen, H. R. and Hansen, H. P. (2013) ‘Someone to hold a hand over me’: The significance of transpersonal ‘attachment’ relationships of Danish Cancer survivors. European Journal of Cancer Care 22 (6): 726–737. https://doi.org/10.1111/ecc.12097
Assing Hvidt, E., Søndergaard, J., Ammentorp, J., Bjerrum, L., Hansen, D. G., Olesen, F., Pedersen, S. S., Timm, H. U., Timmermann, C. and Hvidt, N. C. (2016) The existential dimension in general practice: Identifying understandings and experiences of general practitioners in Denmark. Scandinavian Journal of Primary Health Care 34 (4): 385–393. https://doi.org/10.1080/02813432.2016.1249064
Berger, P. L. and Luckmann, T. (1966) The Social Construction of Reality: A Treatise in the Sociology of Knowledge. Garden City, NY: Anchor Books.
Borrell-Carrió, F., Suchman, A. L. and Epstein R. M. (2004) The biopsychosocial model 25 years later: Principles, practice, and scientific inquiry. Annals of Family Medicine 2 (6): 576–582. https://doi.org/10.1370/afm.245
Butalid, L., Bensing, J. M. and Verhaak, P. F. (2014) Talking about psychosocial problems: An observational study on changes in doctor-patient communication in general practice between 1977 and 2008. Patient Education and Counseling 94 (3): 314–321. https://doi.org/10.1016/j.pec.2013.11.004
Chibnall, J. T., Bennett, M. L., Videen, S. D., Duckro, P. N. and Miller, D. K. (2004) Identifying barriers to psychosocial spiritual care at the end of life: A physician group study. American Journal of Hospice and Palliative Medicine 21 (6): 419–426. https://doi.org/10.1177/104990910402100607
Coulehan, J. and Williams, P. C. (2003) Conflicting professional values in medical education. Cambridge Quarterly of Healthcare Ethics 12 (1): 7–20. https://doi.org/10.1017/S0963180103121032
Derksen, F., Bensing, J., Kuiper, S., van Meerendonk, M. and Lagro-Janssen, A. (2015) Empathy: What does it mean for GPs? A qualitative study. Journal of Family Practice 32 (1): 94–100. https://doi.org/10.1093/fampra/cmu080
Dyer, A. R. (2011) The need for a new ‘new medical model’: A bio-psychosocial-spiritual model. Southern Medical Journal 104 (4): 297–298. https://doi.org/10.1097/SMJ.0b013e318208767b
Engel, G. L. (1977) The need for a new medical model: A challenge for biomedicine. Science 196 (4286): 129–136. https://doi.org/10.1126/science.847460
Gadamer, H.-G. (1990) Wahrheit und Methode: Grundzüge einer philosophischen Hermeneutik, Tübingen: Mohr Siebeck.
Gallup, W. (2010) Religiosity Highest in World’s Poorest Nations. Retrieved from: http://www.gallup.com/poll/142727/Religiosity-Highest-World-Poorest-Nations.aspx-1.
Grønvold, M., Pedersen, C., Jensen, C., Faber, M. and Johnsen, A. (2006) Kræftpatientens Verden. En Undersøgelse af hvad Danske Kræftpatienter har Brug for [The World of the Cancer Patient: An Investigation of what Danish Cancer Patients are in Need Of]. Copenhagen: Kræftens Bekæmpelse.
Gundelach, P. (2011) Små og Store Forandringer. Danskernes Værdier siden 1981 [Small and Big Changes: The Values of the Danes since 1981]. Copenhagen: Hans Reitzels Forlag.
Habermas, J. (1987) The Theory of Communicative Action. Boston: Beacon Press.
Heidegger, M. (1993) Sein und Zeit. Tübingen: Max Niemeyer Verlag.
Johannessen-Henry, C. T., Delatour, I., Bidstrup, P. E., Dalton, S. O. and Johansen, C. (2013) Associations between faith, distress and mental adjustment – A Danish survivorship study. Acta Oncologica 52 (2): 364–371. https://doi.org/10.3109/0284186X.2012.744141
Kirkeministeriet. (2016) Folkekirkens medlemstal. Retrieved from: http://www.km.dk/folkekirken/kirkestatistik/folkekirkens-medlemstal/.
Koenig, H., King, D. and Carson, V. B. (2012) Handbook of Religion and Health. New York: Oxford University Press.
La Cour, P. (2008) Existential and religious issues when admitted to hospital in a secular society: Patterns of change. Mental Health, Religion & Culture 11 (8): 769–782. https://doi.org/10.1080/13674670802024107
La Cour, P. and Hvidt, N. C. (2010) Research on meaning-making and health in secular society: Secular, spiritual and religious existential orientations. Social Science & Medicine 71 (7): 1292–1299. https://doi.org/10.1016/j.socscimed.2010.06.024
Liamputtong, P. (2011) Focus Group Methodology: Principle and Practice. London: Sage. https://doi.org/10.4135/9781473957657
Mishler, E. (1984) The Discourse of Medicine: The Dialectics of Medical Interviews. Norwood, NJ: Ablex.
Nettleton, S., Burrows, R. and Watt, I. (2008) Regulating medical bodies? The consequences of the ‘modernisation’ of the NHS and the disembodiment of clinical knowledge. Sociology of Health and Illness 30 (3): 333-348. https://doi.org/10.1111/j.1467-9566.2007.01057.x
Pedersen, H. F., Pedersen, C. G., Pargament, K. I. and Zachariae, B. (2013) Religious coping and quality of life among severely ill lung patients in a secular society. International Journal for the Psychology of Religion 23 (3): 188–203. https://doi.org/10.1080/10508619.2012.728068
Pedersen, K. M., Andersen, J. S. and Søndergaard, J. (2012) General practice and primary health care in Denmark. Journal of the American Board of Family Medicine 25 (1): 34–38. https://doi.org/10.3122/jabfm.2012.02.110216
Pesut, B., Fowler, M., Taylor, E. J., Reimer-Kirkham, S. and Sawatzky, R. (2008) Conceptualising spirituality and religion for healthcare. Journal of Clinical Nursing 17 (21): 2803–2810. https://doi.org/10.1111/j.1365-2702.2008.02344.x
Rosen, I. (2009) ‘I’m a Believer – but I’ll be Damned if I’m Religious’: Belief and Religion in the Greater Copenhagen Area – A Focus Group Study. Lund: Lunds Universitet.
Salander, P. (2012) The emperor’s new clothes: Spirituality. A concept based on questionable ontology and circular findings. Archive for the Psychology of Religion 34 (1): 17–32. https://doi.org/10.1163/157361212X645241
Smith, J. A., Flowers, P. and Larkin, M. (2009) Interpretative Phenomenological Analysis: Theory, Method and Research. London: Sage.
Sulmasy, D. P. (2002) A biopsychosocial-spiritual model for the care of patients at the end of life. Gerontologist 42 (3): 24–33. https://doi.org/10.1093/geront/42.suppl_3.24
Taylor, C. (2007) A Secular Age. Cambridge, MA: Harvard University Press.
Vermandere, M., Choi, Y. N., De Brabandere, H., Decouttere, R., De Meyere, E., Gheysens, E., Nickmans, B., Schoutteten, M., Seghers, L., Truijens, J., Vandenberghe, S., Van De Wiele, S., Van Oevelen, L. A. and Aertgeerts, B. (2012) GPs’ views concerning spirituality and the use of the FICA tool in palliative care in Flanders: A qualitative study. British Journal of General Practice 62 (603): 718–725. https://doi.org/10.3399/bjgp12X656865
Wear, D. and Castellani, B. (2000) The development of professionalism: Curriculum matters. Academic Medicine 75 (6): 602–611. https://doi.org/10.1097/00001888-200006000-00009
Zuckerman P. (2008) Society Without God. New York: New York University Press.
Alonso, Y. (2004) The biopsychosocial model in medical research: The evolution of the health concept over the last two decades. Patient Education and Counseling 53 (2): 239–244. https://doi.org/10.1016/S0738-3991(03)00146-0
Andersen, P. B. and Lüchau, P. (2011) Individualisering og aftraditionalisering af danskernes religiøse værdier [The individualization and detraditionalization of the values of the Danes]. In P. Gundelach (ed.) Små og Store Forandringer. Danskernes Værdier siden 1981 [Small and Big Changes: The Values of the Danes since 1981]. Copenhagen: Hans Reitzels Forlag.
Andersen, R. S. and Vedsted, P. (2015) Juggling efficiency: An ethnographic study exploring healthcare seeking practices and institutional logics in Danish primary care settings. Social Science & Medicine 128: 239–245. https://doi.org/10.1016/j.socscimed.2015.01.037
Assing Hvidt, E., Iversen, H. R. and Hansen, H. P. (2012) Belief and meaning orientations among Danish cancer patients in rehabilitation: A Taylorian perspective. Spiritual Care 1 (3): 1–22.
Assing Hvidt, E., Iversen, H. R. and Hansen, H. P. (2013) ‘Someone to hold a hand over me’: The significance of transpersonal ‘attachment’ relationships of Danish Cancer survivors. European Journal of Cancer Care 22 (6): 726–737. https://doi.org/10.1111/ecc.12097
Assing Hvidt, E., Søndergaard, J., Ammentorp, J., Bjerrum, L., Hansen, D. G., Olesen, F., Pedersen, S. S., Timm, H. U., Timmermann, C. and Hvidt, N. C. (2016) The existential dimension in general practice: Identifying understandings and experiences of general practitioners in Denmark. Scandinavian Journal of Primary Health Care 34 (4): 385–393. https://doi.org/10.1080/02813432.2016.1249064
Berger, P. L. and Luckmann, T. (1966) The Social Construction of Reality: A Treatise in the Sociology of Knowledge. Garden City, NY: Anchor Books.
Borrell-Carrió, F., Suchman, A. L. and Epstein R. M. (2004) The biopsychosocial model 25 years later: Principles, practice, and scientific inquiry. Annals of Family Medicine 2 (6): 576–582. https://doi.org/10.1370/afm.245
Butalid, L., Bensing, J. M. and Verhaak, P. F. (2014) Talking about psychosocial problems: An observational study on changes in doctor-patient communication in general practice between 1977 and 2008. Patient Education and Counseling 94 (3): 314–321. https://doi.org/10.1016/j.pec.2013.11.004
Chibnall, J. T., Bennett, M. L., Videen, S. D., Duckro, P. N. and Miller, D. K. (2004) Identifying barriers to psychosocial spiritual care at the end of life: A physician group study. American Journal of Hospice and Palliative Medicine 21 (6): 419–426. https://doi.org/10.1177/104990910402100607
Coulehan, J. and Williams, P. C. (2003) Conflicting professional values in medical education. Cambridge Quarterly of Healthcare Ethics 12 (1): 7–20. https://doi.org/10.1017/S0963180103121032
Derksen, F., Bensing, J., Kuiper, S., van Meerendonk, M. and Lagro-Janssen, A. (2015) Empathy: What does it mean for GPs? A qualitative study. Journal of Family Practice 32 (1): 94–100. https://doi.org/10.1093/fampra/cmu080
Dyer, A. R. (2011) The need for a new ‘new medical model’: A bio-psychosocial-spiritual model. Southern Medical Journal 104 (4): 297–298. https://doi.org/10.1097/SMJ.0b013e318208767b
Engel, G. L. (1977) The need for a new medical model: A challenge for biomedicine. Science 196 (4286): 129–136. https://doi.org/10.1126/science.847460
Gadamer, H.-G. (1990) Wahrheit und Methode: Grundzüge einer philosophischen Hermeneutik, Tübingen: Mohr Siebeck.
Gallup, W. (2010) Religiosity Highest in World’s Poorest Nations. Retrieved from: http://www.gallup.com/poll/142727/Religiosity-Highest-World-Poorest-Nations.aspx-1.
Grønvold, M., Pedersen, C., Jensen, C., Faber, M. and Johnsen, A. (2006) Kræftpatientens Verden. En Undersøgelse af hvad Danske Kræftpatienter har Brug for [The World of the Cancer Patient: An Investigation of what Danish Cancer Patients are in Need Of]. Copenhagen: Kræftens Bekæmpelse.
Gundelach, P. (2011) Små og Store Forandringer. Danskernes Værdier siden 1981 [Small and Big Changes: The Values of the Danes since 1981]. Copenhagen: Hans Reitzels Forlag.
Habermas, J. (1987) The Theory of Communicative Action. Boston: Beacon Press.
Heidegger, M. (1993) Sein und Zeit. Tübingen: Max Niemeyer Verlag.
Johannessen-Henry, C. T., Delatour, I., Bidstrup, P. E., Dalton, S. O. and Johansen, C. (2013) Associations between faith, distress and mental adjustment – A Danish survivorship study. Acta Oncologica 52 (2): 364–371. https://doi.org/10.3109/0284186X.2012.744141
Kirkeministeriet. (2016) Folkekirkens medlemstal. Retrieved from: http://www.km.dk/folkekirken/kirkestatistik/folkekirkens-medlemstal/.
Koenig, H., King, D. and Carson, V. B. (2012) Handbook of Religion and Health. New York: Oxford University Press.
La Cour, P. (2008) Existential and religious issues when admitted to hospital in a secular society: Patterns of change. Mental Health, Religion & Culture 11 (8): 769–782. https://doi.org/10.1080/13674670802024107
La Cour, P. and Hvidt, N. C. (2010) Research on meaning-making and health in secular society: Secular, spiritual and religious existential orientations. Social Science & Medicine 71 (7): 1292–1299. https://doi.org/10.1016/j.socscimed.2010.06.024
Liamputtong, P. (2011) Focus Group Methodology: Principle and Practice. London: Sage. https://doi.org/10.4135/9781473957657
Mishler, E. (1984) The Discourse of Medicine: The Dialectics of Medical Interviews. Norwood, NJ: Ablex.
Nettleton, S., Burrows, R. and Watt, I. (2008) Regulating medical bodies? The consequences of the ‘modernisation’ of the NHS and the disembodiment of clinical knowledge. Sociology of Health and Illness 30 (3): 333-348. https://doi.org/10.1111/j.1467-9566.2007.01057.x
Pedersen, H. F., Pedersen, C. G., Pargament, K. I. and Zachariae, B. (2013) Religious coping and quality of life among severely ill lung patients in a secular society. International Journal for the Psychology of Religion 23 (3): 188–203. https://doi.org/10.1080/10508619.2012.728068
Pedersen, K. M., Andersen, J. S. and Søndergaard, J. (2012) General practice and primary health care in Denmark. Journal of the American Board of Family Medicine 25 (1): 34–38. https://doi.org/10.3122/jabfm.2012.02.110216
Pesut, B., Fowler, M., Taylor, E. J., Reimer-Kirkham, S. and Sawatzky, R. (2008) Conceptualising spirituality and religion for healthcare. Journal of Clinical Nursing 17 (21): 2803–2810. https://doi.org/10.1111/j.1365-2702.2008.02344.x
Rosen, I. (2009) ‘I’m a Believer – but I’ll be Damned if I’m Religious’: Belief and Religion in the Greater Copenhagen Area – A Focus Group Study. Lund: Lunds Universitet.
Salander, P. (2012) The emperor’s new clothes: Spirituality. A concept based on questionable ontology and circular findings. Archive for the Psychology of Religion 34 (1): 17–32. https://doi.org/10.1163/157361212X645241
Smith, J. A., Flowers, P. and Larkin, M. (2009) Interpretative Phenomenological Analysis: Theory, Method and Research. London: Sage.
Sulmasy, D. P. (2002) A biopsychosocial-spiritual model for the care of patients at the end of life. Gerontologist 42 (3): 24–33. https://doi.org/10.1093/geront/42.suppl_3.24
Taylor, C. (2007) A Secular Age. Cambridge, MA: Harvard University Press.
Vermandere, M., Choi, Y. N., De Brabandere, H., Decouttere, R., De Meyere, E., Gheysens, E., Nickmans, B., Schoutteten, M., Seghers, L., Truijens, J., Vandenberghe, S., Van De Wiele, S., Van Oevelen, L. A. and Aertgeerts, B. (2012) GPs’ views concerning spirituality and the use of the FICA tool in palliative care in Flanders: A qualitative study. British Journal of General Practice 62 (603): 718–725. https://doi.org/10.3399/bjgp12X656865
Wear, D. and Castellani, B. (2000) The development of professionalism: Curriculum matters. Academic Medicine 75 (6): 602–611. https://doi.org/10.1097/00001888-200006000-00009
Zuckerman P. (2008) Society Without God. New York: New York University Press.
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2018-03-27
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Assing Hvidt, E., Søndergaard, J., Hansen, D. G., Gulbrandsen, P., Ammentorp, J., Timmermann, C., & Hvidt, N. C. (2018). ‘We are the barriers’: Danish general practitioners’ interpretations of why the existential and spiritual dimensions are neglected in patient care. Communication and Medicine, 14(2), 108-120. https://doi.org/10.1558/cam.32147
