Title:
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Making a difference : a study examining the experience of doctors working in A & E in treating people who present with self-mutilation
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In this thesis I present the results of a grounded theory analysis of the experiences of doctors working in Accident & Emergency (A&E) in treating people who self-mutilate. An overview of the literature examines the different terminologies used and the different meanings and explanations for self-mutilation which are held by the public, medical professionals and those working in the field of mental health, as well as those who self-mutilate, all of which overlap and influence one another. In this context I examine the limited literature investigating health professionals' responses to self-mutilation. Negative attitudes and emotional responses are often reported. The present study sought to investigate the specific experiences of junior doctors working in an inner-London A&E. Eight participants were interviewed to produce rich data which was analysed using grounded theory methodology, in order to provide an in-depth understanding of their experiences. The analysis highlighted the significance of working in the social context of A&E, and of perceptions of the role of doctor, both of which influenced participants' experiences in every aspect of their work. In particular participants reported wanting to 'make a difference' which was generally seen as having a positive impact upon health outcome. Participants generally believed that they could not 'make a difference' when treating patients who had self-mutilated, except in the unusual instance where they felt that they had been able to engage the patient. This experience had a negative impact on their emotional response to this patient group and the degree to which they felt rewarded. The findings are discussed in relation to the literature and a critical review of the study is presented. Implications of the study are outlined, which include recommendations for further training and for service provision.
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