The future role of general practice

– continuing professional development and the wellbeing of the GP

Dorte Kjeldmand, GP, PhD
University of Uppsala, Sweden
Department of Public Health and Caring Sciences
Section for Health Services Research

Eksjö Primary Care Centre, Sweden

(Picture)

The core of the medical profession

The encounter with the patient

  • To make contact and understand what the patient needs and what kind of help s/he wants
  • To be able to use ones professional competence for the benefit of the patient without being consumed oneself
  • To contribute to increasing the patient's understanding and competence in his/her situation

But -

  • It keeps you going and
  • it wears you out

Problems:

  • Overworked and tired GPs, who are frustrated and confused about their role
  • This may lead to burn-out
  • Many consider early retirement

More problems:

  • The public's trust in the health care system has declined
  • Patients are dissatisfied
  • Physicians' role and authority is questioned
  • In a modern, secularized society people seek health care for existential frustration and discontent
  • Demands and guidelines. Evidence-based medicine versus patient-centeredness? Or both?

49 VAS-questions, 3 examples:

1. Can you take your coffee break every day?

_________________

0 1 2 3 4 5 6 7 8 9 10

No, never Yes, always

2. Do you find patients with psychosomatic problems a time-consuming burden?

_________________

0 1 2 3 4 5 6 7 8 9 10

Yes No

3. Do you sometimes refer patients or take "unnecessary" tests in order to end the consultation?

_________________

0 1 2 3 4 5 6 7 8 9 10

Yes, often No, never

(3 pictures)

Informants and method

  • 9 GPs: 4 women and 5 men
  • Age: 42-60 years
  • Duration of Balint group participation: 2-14 years
  • From 6 different groups with 6 different leaders in southern Sweden
  • Audio-taped, transcribed verbatim
  • Analysis: Gunnar Karlsson's EPP-method (Empirical Phenomenological Psychological)

Findings

(interrelating themes):

In the Balint group the physician's

  • Professional identity
  • Competence
  • Sense of security

are developed through

Parallel processes: physician-patient / physician-Balint group leading to increased satisfaction and endurance in work

Balint group activity

  • Strengthens and develops professional identity
  • Promotes patient-centeredness
  • Strengthens relations between colleagues
  • Increases feeling of control in work
  • Increases understanding of what happens in human relations
  • Should be conducted professionally
  • Should be voluntary