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Published in: BMC Primary Care 1/2018

Open Access 01-12-2018 | Research article

General practitioners’ attitudes towards patients with poorly controlled type 2 diabetes: a qualitative study

Authors: Anja Wollny, Michael Pentzek, Oliver Rudolf Herber, Heinz-Harald Abholz, Jürgen in der Schmitten, Andrea Icks, Stefan Wilm, Elisabeth Gummersbach

Published in: BMC Primary Care | Issue 1/2018

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Abstract

Background

Patients with type 2 diabetes mellitus (T2DM) with poor glycaemic control can represent a challenge from the perspective of the general practitioner (GP). Apart from patient-sided factors, the understanding of GPs’ attitudes may provide ideas for improved management in these patients. The aim of this study is to reveal attitudes of GPs towards T2DM patients with poor metabolic control.

Methods

Qualitative research in German general practice; 20 GPs, randomly chosen from participants of a larger study; in-depth narrative interviews, audio-recorded and transcribed; inductive coding and categorisation in a multi-professional team; abstraction of major themes in terms of attitudinal responses.

Results

1) Orientation on laboratory parameters: GPs see it as their medical responsibility to achieve targets, which instil a sense of security. 2) Resignation: GPs believe their efforts are in vain and see their role as being undermined. 3) Devaluation of the patient: GPs blame the “non-compliance” of the patients and experience care as a series of conflicts. 4) Fixed role structure: The expert GP on the one hand, the ignorant patient on the other. 5) Solidarity with the patient: GPs appreciate a doctor-patient relationship in terms of partnership.

Conclusions

The conflict GPs experience between their sense of duty and feelings of futility may lead to perceptions such as personal defeat and insecurity. GPs (and patients) may benefit from adjusting the patient-doctor relationship with regard to shared definitions of realistic and authentic goals.
Literature
1.
go back to reference Hogg M, Vaughan G. Social psychology. London: Prentice-Hall; 2005. Hogg M, Vaughan G. Social psychology. London: Prentice-Hall; 2005.
2.
go back to reference Fazio RH, Roskos-Ewoldsen DR. Acting as we feel: when and how attitudes guide behavior. In: Shavitt S, Brock TC, editors. Persuasion: psychological insights and perspectives. Needham Heights MA: Allyn Bacon; 1994. p. 71–93. Fazio RH, Roskos-Ewoldsen DR. Acting as we feel: when and how attitudes guide behavior. In: Shavitt S, Brock TC, editors. Persuasion: psychological insights and perspectives. Needham Heights MA: Allyn Bacon; 1994. p. 71–93.
3.
go back to reference Cameron KA. Theories in health communication research. A practitioner’s guide to persuasion: an overview of 15 selected persuasion theories, models and frameworks. Patient Educ Couns. 2009;74:309–17.CrossRefPubMed Cameron KA. Theories in health communication research. A practitioner’s guide to persuasion: an overview of 15 selected persuasion theories, models and frameworks. Patient Educ Couns. 2009;74:309–17.CrossRefPubMed
4.
go back to reference Freeman J, Loewe R. Barriers to communication about diabetes mellitus. Patients’ and practitioners’ different views of the disease. J Fam Pract. 2000;49:507–12.PubMed Freeman J, Loewe R. Barriers to communication about diabetes mellitus. Patients’ and practitioners’ different views of the disease. J Fam Pract. 2000;49:507–12.PubMed
5.
go back to reference Olivarius N, Palmvig B, Helms Andreasen A, Thorgersen J, Hundrup C. An educational model for improving diet counselling in primary care. A case study of the creative use of doctors’ own diet, their attitudes to it and to nutritional counselling of their patients with diabetes. Patient Educ Couns. 2005;58:199–202.CrossRef Olivarius N, Palmvig B, Helms Andreasen A, Thorgersen J, Hundrup C. An educational model for improving diet counselling in primary care. A case study of the creative use of doctors’ own diet, their attitudes to it and to nutritional counselling of their patients with diabetes. Patient Educ Couns. 2005;58:199–202.CrossRef
6.
go back to reference Street RL Jr, Gordon H, Haidet P. Practitioners’ communication and perceptions of patients: is it how they look, how they talk, or is it just the doctor? Soc Sci Med. 2007;65:586–98.CrossRefPubMedPubMedCentral Street RL Jr, Gordon H, Haidet P. Practitioners’ communication and perceptions of patients: is it how they look, how they talk, or is it just the doctor? Soc Sci Med. 2007;65:586–98.CrossRefPubMedPubMedCentral
7.
go back to reference An PG, Rabatin JS, Manwell LB, Linzer M, Brown RL, Schwartz MD for the MEMO Investigators. Burden of difficult encounters in primary are: data from the minimizing error, maximizing out-comes study. Arch Intern Med. 2009;169:410–4.CrossRefPubMed An PG, Rabatin JS, Manwell LB, Linzer M, Brown RL, Schwartz MD for the MEMO Investigators. Burden of difficult encounters in primary are: data from the minimizing error, maximizing out-comes study. Arch Intern Med. 2009;169:410–4.CrossRefPubMed
8.
go back to reference Street RL Jr, Makoul G, Arora NK, Epstein RM. How does communication heal? Pathways linking clinician-patient communication to health outcomes. Patient Educ Couns. 2009;74:295–301.CrossRefPubMed Street RL Jr, Makoul G, Arora NK, Epstein RM. How does communication heal? Pathways linking clinician-patient communication to health outcomes. Patient Educ Couns. 2009;74:295–301.CrossRefPubMed
10.
go back to reference Altenhofen L, Hagen B, Hansen L. Ergebnisse zur DMP-Umsetzung in der region Nordrhein. In: Günster C, Klose J, Schmacke N, editors. Versorgungs-report 2011: Schwerpunkt Chronische Erkrankungen. Stuttgart: Schattauer; 2010. p. 69–72. Altenhofen L, Hagen B, Hansen L. Ergebnisse zur DMP-Umsetzung in der region Nordrhein. In: Günster C, Klose J, Schmacke N, editors. Versorgungs-report 2011: Schwerpunkt Chronische Erkrankungen. Stuttgart: Schattauer; 2010. p. 69–72.
11.
go back to reference Grant RW, Ashburner JM, Hong CS, Chang Y, Barry MJ, Atlas SJ. Defining patient complexity from the primary care Physician's perspective. Ann Intern Med. 2011;155:797–804.CrossRefPubMed Grant RW, Ashburner JM, Hong CS, Chang Y, Barry MJ, Atlas SJ. Defining patient complexity from the primary care Physician's perspective. Ann Intern Med. 2011;155:797–804.CrossRefPubMed
12.
go back to reference Jeavons D, Hungin APS, Cornford CS. Patients with poorly controlled diabetes in primary care: healthcare clinicians’ beliefs and attitudes. Postgrad Med J. 2006;82:347–50.CrossRefPubMedPubMedCentral Jeavons D, Hungin APS, Cornford CS. Patients with poorly controlled diabetes in primary care: healthcare clinicians’ beliefs and attitudes. Postgrad Med J. 2006;82:347–50.CrossRefPubMedPubMedCentral
13.
go back to reference Moreau A, Aroles V, Souweine G, et al. Patient versus general physician perception of problems with treatment adherence in type 2 diabetes. Eur J Gen Pract. 2009;15:147–53.CrossRefPubMed Moreau A, Aroles V, Souweine G, et al. Patient versus general physician perception of problems with treatment adherence in type 2 diabetes. Eur J Gen Pract. 2009;15:147–53.CrossRefPubMed
14.
go back to reference Anderson R, Robins L. How do we know? Reflections on qualitative research in diabetes. Diabetes Care. 1998;21:1387–8.CrossRefPubMed Anderson R, Robins L. How do we know? Reflections on qualitative research in diabetes. Diabetes Care. 1998;21:1387–8.CrossRefPubMed
15.
go back to reference Wilm S, Abholz HH, Gummersbach E, Icks A, Pentzek M. Patients with poorly regulated type 2 diabetes – health psychological characterization. Diabetologe. 2014;10:200–206. [German]. Wilm S, Abholz HH, Gummersbach E, Icks A, Pentzek M. Patients with poorly regulated type 2 diabetes – health psychological characterization. Diabetologe. 2014;10:200–206. [German].
16.
go back to reference Jovchelovitch S, Bauer MW. Narrative interviewing. In: Bauer MW, Gaskell G, editors. Qualitative research with text, image and sound: a practical handbook. Thousand Oaks: Sage Publications; 2000. p. 57–74. Jovchelovitch S, Bauer MW. Narrative interviewing. In: Bauer MW, Gaskell G, editors. Qualitative research with text, image and sound: a practical handbook. Thousand Oaks: Sage Publications; 2000. p. 57–74.
17.
go back to reference Chase SE. Taking narrative seriously: consequences for method and theory in interview studies. In: Lincoln YS, Denzin NK, editors. Turning points in qualitative research. Lanham: AltaMira Press; 2003. p. 273–96. Chase SE. Taking narrative seriously: consequences for method and theory in interview studies. In: Lincoln YS, Denzin NK, editors. Turning points in qualitative research. Lanham: AltaMira Press; 2003. p. 273–96.
18.
go back to reference Hsieh HF, Shannon S. Three approaches to qualitative content analysis. Qual Health Res. 2005;15:1277–88.CrossRefPubMed Hsieh HF, Shannon S. Three approaches to qualitative content analysis. Qual Health Res. 2005;15:1277–88.CrossRefPubMed
21.
22.
go back to reference Brown J, Harris S, Webster-Bogaet S, Wetmore S, Faulds C, Steward M. The role of patient, practitioner and systemic factors in the management of type 2 diabetes mellitus. Fam Pract. 2002;19:344–9.CrossRefPubMed Brown J, Harris S, Webster-Bogaet S, Wetmore S, Faulds C, Steward M. The role of patient, practitioner and systemic factors in the management of type 2 diabetes mellitus. Fam Pract. 2002;19:344–9.CrossRefPubMed
23.
go back to reference Wens J, Vermeire E, Van Royen P, Sabbe B, Denekens J. Practitioners’ perspectives of type 2 diabetes patients’ adherence to treatment: a qualitative analysis of barriers and solutions. BMC Fam Pract. 2005;6:20.CrossRefPubMedPubMedCentral Wens J, Vermeire E, Van Royen P, Sabbe B, Denekens J. Practitioners’ perspectives of type 2 diabetes patients’ adherence to treatment: a qualitative analysis of barriers and solutions. BMC Fam Pract. 2005;6:20.CrossRefPubMedPubMedCentral
24.
go back to reference Ketterer F, Symons L, Lambrechts MC, et al. What factors determine Belgian general practitioners’ approaches to detecting and managing substance abuse? A qualitative study based on the I-change model. BMC Fam Pract. 2014;15:119.CrossRefPubMedPubMedCentral Ketterer F, Symons L, Lambrechts MC, et al. What factors determine Belgian general practitioners’ approaches to detecting and managing substance abuse? A qualitative study based on the I-change model. BMC Fam Pract. 2014;15:119.CrossRefPubMedPubMedCentral
25.
go back to reference Nabitz U, van den Brink W, Walburg J. A quality framework for addiction treatment programs. Addict Behav. 2005;30:1254–60.CrossRefPubMed Nabitz U, van den Brink W, Walburg J. A quality framework for addiction treatment programs. Addict Behav. 2005;30:1254–60.CrossRefPubMed
26.
go back to reference Heisler M, Vijan S, Anderson RM, Ubel PA, Bernstein SJ, Hofer TP. When do patients and their practitioners agree on diabetes treatment goals and strategies, and what difference does it make? J Gen Intern Med. 2003;18:893–902.CrossRefPubMedPubMedCentral Heisler M, Vijan S, Anderson RM, Ubel PA, Bernstein SJ, Hofer TP. When do patients and their practitioners agree on diabetes treatment goals and strategies, and what difference does it make? J Gen Intern Med. 2003;18:893–902.CrossRefPubMedPubMedCentral
27.
go back to reference Beverly E, Hultgren B, Brooks K, Ritholz M, Abrahamson MJ, Weinger K. Understanding physicians’ challenges when treating type 2 diabetic patients’ social and emotional difficulties. Diabetes Care. 2011;34:1086–8.CrossRefPubMedPubMedCentral Beverly E, Hultgren B, Brooks K, Ritholz M, Abrahamson MJ, Weinger K. Understanding physicians’ challenges when treating type 2 diabetic patients’ social and emotional difficulties. Diabetes Care. 2011;34:1086–8.CrossRefPubMedPubMedCentral
28.
go back to reference Chapman EN, Kaatz A, Carnes M. Physicians and implicit bias: how doctors may unwittingly perpetuate health care disparities. J Gen Intern Med. 2013;28:1504–10.CrossRefPubMedPubMedCentral Chapman EN, Kaatz A, Carnes M. Physicians and implicit bias: how doctors may unwittingly perpetuate health care disparities. J Gen Intern Med. 2013;28:1504–10.CrossRefPubMedPubMedCentral
29.
go back to reference Galinsky AD, Moskowitz GB. Perspective-taking: decreasing stereotype expression, stereotype accessibility, and in-group favoritism. J Pers Soc Psychol. 2000;78:708–24.CrossRefPubMed Galinsky AD, Moskowitz GB. Perspective-taking: decreasing stereotype expression, stereotype accessibility, and in-group favoritism. J Pers Soc Psychol. 2000;78:708–24.CrossRefPubMed
30.
go back to reference Locke EA, Latham GP. Building a practically useful theory of goal setting and task motivation. Am Psychol. 2002;57:705–17.CrossRefPubMed Locke EA, Latham GP. Building a practically useful theory of goal setting and task motivation. Am Psychol. 2002;57:705–17.CrossRefPubMed
31.
go back to reference Pierce D, Gunn J. Using problem solving therapy in general practice. Aust Fam Physician. 2007;36:230–3.PubMed Pierce D, Gunn J. Using problem solving therapy in general practice. Aust Fam Physician. 2007;36:230–3.PubMed
32.
go back to reference Asimakopoulou K, Newton P, Sinclair AJ, Scambler S. Health care professionals’ understanding and day-to-day practice of patient empowerment in diabetes; time to pause for thought? Diabetes Res Clin Pract. 2012;95:224–9.CrossRefPubMed Asimakopoulou K, Newton P, Sinclair AJ, Scambler S. Health care professionals’ understanding and day-to-day practice of patient empowerment in diabetes; time to pause for thought? Diabetes Res Clin Pract. 2012;95:224–9.CrossRefPubMed
Metadata
Title
General practitioners’ attitudes towards patients with poorly controlled type 2 diabetes: a qualitative study
Authors
Anja Wollny
Michael Pentzek
Oliver Rudolf Herber
Heinz-Harald Abholz
Jürgen in der Schmitten
Andrea Icks
Stefan Wilm
Elisabeth Gummersbach
Publication date
01-12-2018
Publisher
BioMed Central
Published in
BMC Primary Care / Issue 1/2018
Electronic ISSN: 2731-4553
DOI
https://doi.org/10.1186/s12875-018-0751-4

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