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Title: Beneficence, boundaries and big brother : patients' and doctors' construction of 'personal care' in General Practice medicine
Author: Adam, Rachel Pirrie
Awarding Body: University of Edinburgh
Current Institution: University of Edinburgh
Date of Award: 2003
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This study arises from widely-voiced concerns within academic and professional communities that changes, mainly in the organization of the NHS, have placed the future of 'personal care' in General Practice in doubt. Personal care may be considered one of the foundational, core values of the profession's ontology and its claim for specialist status. However, the concept of the personal has only an underlying and taken-for-granted presence in most related thinking and empirical research, and has been implicitly conceptualized in a myriad of ways. There is a paucity of research that has either explored 'the personal' as a socially constructed concept or attempted to understand lay perspectives of it. Using a qualitative methodology, twenty-three patients, mainly women with young children, and twenty-three General Practitioners (GPs) from the Lothian Health Board area of Scotland were interviewed to explore their understandings and experiences of personal care in General Practice. Patients' and GPs' accounts were strikingly similar and suggest that they were embedded in, and drew upon, a wider discourse of bio-psychosocial medicine. Personal care was constructed as multi-faceted; as the patient-doctor relationship built over time, characterized by mutual knowing and mutual trust, in which the doctor shows a particular consultation style. Interviewees placed significant importance on such care and attributed numerous specific benefits to it. For patients, personal care could be seen as allowing the establishment and maintenance of a legitimate identity that smoothes their path into and through health care systems and as helping to optimise their health status. For doctors, it enshrined the 'spirit of generosity' of care, whilst also permitting identification and control of the 'problematic' patient. However, the level of importance interviewees placed upon personal care was contingent upon attendant circumstances. They also felt it could be disadvantageous and placed boundaries around it. These findings are considered in relation to sociological theories on the patientdoctor relationship. The later work of Foucault on the practices or technologies of the self is found to provide the most adequate understanding of the data's complexity. The findings are also considered in the light of recent and proposed policy developments within primary care, particularly the NHS plans for Scotland and England and the proposed new GP contract for the UK. The thesis concludes that personal care has continuing salience for, at the very least, some patients and doctors in certain contexts and should be preserved within the new organization of primary care services.
Supervisor: Not available Sponsor: Not available
Qualification Name: Thesis (Ph.D.) Qualification Level: Doctoral
EThOS ID:  DOI: Not available