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Cited by 207Patient-Provider Communication in HealthcarePrimary Care and Health OutcomesMedicine, History, and Philosophy

Framing the doctor‐patient relationship in chronic illness: a comparative study of general practitioners’ accounts

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May, Carl, Allison, Gayle, Chapple, Alison, Chew‐Graham, Carolyn, Dixon, Clare, Gask, Linda, Graham, Ruth, Rogers, Anne +1 more·2004·Sociology of Health & Illness
DOI 10.1111/j.1467-9566.2004.00384.x
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Abstract

Abstract How family doctors conceptualise chronic illness in the consultation has important implications for both the delivery of medical care, and its experience by patients. In this paper, we present the results of a re‐analysis of qualitative data collected in a series of studies of British family doctors between 1995 and 2001, to explore the ways in which the legitimacy and authority of medical knowledge and practice are organised and worked out in relation to three kinds of chronic illness (menorrhagia; depression; and chronic low back pain/medically unexplained symptoms). We present a comparative analysis of (a) the moral evaluation of the patient (and judgements about the legitimacy of symptom presentation); (b) the possibilities of disposal; and (c) doctors’ empathic responses to the patient, in each of these clinical cases. Our analysis defines some of the fundamental conditions through which general practitioners frame their relationships with patients presenting complex but sometimes diffuse combinations of ‘social’, ‘psychological’ and ‘medical’ symptoms. These are fundamental to, yet barely touched by, the increasingly voluminous literature on how doctors should interact with patients. Moving beyond the individual studies from which our data are drawn, we have outlined some of the highly complex and demanding features of what is often seen as routine and unrewarding medical work, and some of the key requirements for the local negotiation of patients’ problems and their meanings (for both patients and doctors) in everyday general practice.

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  • Crucial to the local production of candidacy is the perceived or actual availability and suitability of resources to address that candidacy.

    “Crucial to the local production of candidacy is the perceived or actual availability and suitability of resources to address that candidacy [60,63].”

    From Conducting a critical interpretive synthesis of the literature on access to healthcare by vulnerable groups (2006) · cites this paper as [60]

    The Conclusion says doctors judge patients’ problems in light of the routinely available means of solving them, and links empathy to a perceived successful exit from the consultation. The paper supports the importance of available and suitable responses in GP consultations, but does not frame this as a finding about the local production of candidacy more generally. (LLM, conf=0.78)

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  • Functional gastrointestinal disorders, such as IBS, are by far the most common diagnosis, but symptoms can be difficult to assess and the possibility of colorectal cancer or inflammatory bowel disease (IBD) may create diagnostic uncertainty for clinicians, and anxiety for patients.

    “Functional gastrointestinal disorders, such as IBS, are by far the most common diagnosis, but symptoms can be difficult to assess and the possibility of colorectal cancer or inflammatory bowel disease (IBD) may create diagnostic uncertainty for clinicians, and anxiety for patients.83”

    From British Society of Gastroenterology guidelines on the management of irritable bowel syndrome (2021) · cites this paper as [83]

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  • Doctors' practices are often exercised through a repertoire of routine judgements about the possibilities presented by individual patients and the routinely available means of solving these.

    “May et al's [60] analysis suggests doctors' practices are often exercised through a repertoire of routine judgements about the possibilities presented by individual patients and the routinely available means of solving these.”

    From Conducting a critical interpretive synthesis of the literature on access to healthcare by vulnerable groups (2006) · cites this paper as [60]

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Research works printed but not linked: 8

  1. Chapple, A. (1997) Menorrhagia: general practitioners' and womens' perceptions of this condition and its treatment [Thesis]. University of Manchester. PhD.
  2. Chew-Graham, C. (1999) Chronic low back pain: the interface between explanatory models and medical communications [Thesis]. University of Manchester. MD.
  3. Dixon, C. (2000) A multi-method evaluation of a training intervention for general practitioners in the assessment and management of depression [Thesis]. University of Manchester. PhD.
  4. Parsons, T. (1951) The Social System. London: Routledge and Kegan Paul.
  5. Gabe, J., Calnan, M. and Bury, M. (eds) The Socology of the Health Service. London: Routledge.
  6. Stimson, G. and Webb, B. (1975) Going to See the Doctor. London: Routledge and Kegan Paul.
  7. Stott, N. and Davis, R. (1979) The exceptional potential in every primary care con- sultation, Journal of the Royal College of General Practitioners, 29, 201-05.
  8. Wissow, L.S. (2003) Untitled, Patient Education and Counseling, 49, 2, 103. 14679566, 2004, 2, Downloaded from https://onlinelibrary.wiley.com/doi/10.1111/j.1467-9566.2004.00384.x by Mount Vernon Nazarene University, Wiley Online Library on [17/08/2026]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License · DOI

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Authors
May, C., Allison, G., Chapple, A., Chew‐Graham, C., Dixon, C., Gask, L., Graham, R., Rogers, A., & Roland, M.
Affiliations
  • Newcastle University (GB)
  • University of Oxford (GB)
  • University of Manchester (GB)
Corresponding author
May, Carl
ORCID
Venue
Sociology of Health & Illness
Publisher
Wiley
Published
2004-03
Volume
26
Issue
2
Pages
135-158
ISSN
  • 0141-9889 (ISSN-L)
  • 1467-9566
DOI
10.1111/j.1467-9566.2004.00384.x
OpenAlex
W2011865263
Cited by
207
References
64
Citations by year
2026: 2 · 2025: 3 · 2024: 3 · 2023: 4 · 2022: 9 · 2021: 3 · 2020: 9 · 2019: 8 · 2018: 8 · 2017: 9 · 2016: 8 · 2015: 9 · 2014: 10 · 2013: 13 · 2012: 8
FWCI
33.40
Type
journal article
Language
en
Open access
Licence
onlinelibrary.wiley.com/termsAndConditions#vor (vor)
Locations
  • Sociology of Health & Illness (publishedVersion)
  • PubMed (publishedVersion)
  • Research Explorer (The University of Manchester) (publishedVersion)
  • Lancaster EPrints (Lancaster University) (submittedVersion)
  • ePrints Soton (University of Southampton) (submittedVersion)
  • Newcastle University ePrints (Newcastle Univesity)
Topics
  • Health Sciences › Health Professions › General Health Professions › Patient-Provider Communication in Healthcare
  • Health Sciences › Health Professions › General Health Professions › Primary Care and Health Outcomes
  • Health Sciences › Medicine › Psychiatry and Mental health › Medicine, History, and Philosophy
Keywords
physician-patient relationship, chronic disease, general practitioners, menorrhagia, depression, medically unexplained symptoms, chronic low back pain, medical authority, disposal, empathic responses
MeSH terms
Attitude of Health Personnel, Chronic Disease, Clinical Competence, Depression, Empathy, Female, United Kingdom, Humans, Interviews as Topic, Male, Menorrhagia, Morals, Physician-Patient Relations, Physicians, Family, Sociology, Medical, Somatoform Disorders, Low Back Pain, Qualitative Research

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