Different Narratives In Different Doctor Patient Relationships by Sofie Davidsen

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Different Narratives In Different Doctor Patient Relationships by Sofie Davidsen

  1. 1. Different narratives in different doctor-patient relationships<br />15-10-2009<br />Annette Sofie Davidsen, MD, PhD adavid@sund.ku.dk<br />1<br />
  2. 2. Familypractice<br />Carachterizedby:<br />All sorts of problems<br />Great part of workload is made up of mental disorder<br />Long-extendedknowledge of patients<br />Knowledge of illness story and family story<br />15-10-2009<br />2<br />Annette Sofie Davidsen, MD, PhD adavid@sund.ku.dk<br />
  3. 3. Aim of study<br />15-10-2009<br />Annette Sofie Davidsen, MD, PhD adavid@sund.ku.dk<br />3<br />To explorewhich narratives familyphysicians told about patients withpsychological problems or mental disorder<br />
  4. 4. Narratives <br />15-10-2009<br />4<br />Annette Sofie Davidsen, MD, PhD adavid@sund.ku.dk<br />Increasinginterest in narratives acrossmanydisciplinessince the 1980s<br />The ’narrative turn’<br />
  5. 5. The ’narrative turn’<br />15-10-2009<br />Annette Sofie Davidsen, MD, PhD adavid@sund.ku.dk<br />5<br />In psychology<br />Bruner, J. (1986). ActualMinds, Possible Worlds. Cambridge, Mass.: Harvard UniversityPress.<br />Bruner, J. (1990). Acts of Meaning. Cambridge, Mass.: Harvard UniversityPress.<br />Sarbin, T. R. (1986). Narrative psychology, the storied nature of human conduct. New York: Praeger.<br />Polkinghorne, D. E. (1988). Narrative Knowing and the Human Sciences. Albany, N.Y.: State University of New York Press.<br />
  6. 6. The ’narrative turn’<br />15-10-2009<br />Annette Sofie Davidsen, MD, PhD adavid@sund.ku.dk<br />6<br />In psychotherapy<br />Schafer, R. (1980). Narration in the Psychoanalytic Dialog. Critical Inquiry, 7, 29-53.<br />Spence, D. P. (1982). Narrative Truth and Theoretical Truth. Psychoanalytic Quarterly, 51, 43-69.<br />Angus, L. & Kagan, F. (2007). Empathic Relational Bonds and Personal Agency in Psychotherapy: Implications for Psychotherapy Supervision, Practice, and Research. Psychotherapy:Theory, Research, Practice and Training, 44, 371-377.<br />McLeod, J. (1999). A narrative social constructionist approach to therapeutic empathy. Counselling Psychotherapy Quarterly, 12, 377-394.<br />Schafer, R. (1992). Retelling a life: Narration and Dialogue in Psychoanalysis. New York: Basic Books.<br />
  7. 7. The therapist is never a neutral mirror<br />15-10-2009<br />Annette Sofie Davidsen, MD, PhD adavid@sund.ku.dk<br />7<br />The story is alwayscreated in an interplaybetweentherapist and patient<br />In psychotherapy<br />and<br />In familypractice<br />
  8. 8. 15-10-2009<br />Annette Sofie Davidsen, MD, PhD adavid@sund.ku.dk<br />8<br />Consultations in familypracticecontainmanypsychotherapeutic elements<br />
  9. 9. Method<br />15-10-2009<br />Annette Sofie Davidsen, MD, PhD adavid@sund.ku.dk<br />9<br />In-depthsemi-structured interviews with 14 familyphysicians<br />Invited to tell patient stories<br />Narrative analysis of interviews<br />Descriptive<br />Interpretive<br />
  10. 10. Results<br />15-10-2009<br />Annette Sofie Davidsen, MD, PhD adavid@sund.ku.dk<br />10<br />Different participants told completelydifferentstories<br />Differentthemes<br />Different narrative styles<br />Four types<br />Storieswithdetaileddescription of patients’ situation<br />Storiesabout emotions and relationships<br />Storiesabout irritation<br />Storiesaboutcategorization and biomedicalperspectives<br />
  11. 11. 15-10-2009<br />Annette Sofie Davidsen, MD, PhD adavid@sund.ku.dk<br />11<br />Each participant told the same type of narrative<br /> – the same narrative style – <br />through the entire interview<br />
  12. 12. Storieswithdetaileddescription of patients’ situation<br />15-10-2009<br />Annette Sofie Davidsen, MD, PhD adavid@sund.ku.dk<br />12<br />Easy and natural to tellstories<br />Detailedstories<br />Deep knowledge<br />Ownreflections<br />Engagement <br />
  13. 13. 15-10-2009<br />Annette Sofie Davidsen, MD, PhD adavid@sund.ku.dk<br />13<br />I think it’s fantastic, to deal with different life stories, and to relate them to the their present lives, well, also the broadness you have as a family physician, children, wives and husbands and – well it’s a fantastic approach. And it’s a fantastic knowledge you possess. <br />
  14. 14. Storiesabout emotions and relationships<br />15-10-2009<br />Annette Sofie Davidsen, MD, PhD adavid@sund.ku.dk<br />14<br />Patient’semotionalreaction and the relationship had a creativeinfluenceon the story<br />And I think, then she experiences a relation between two human beings. That I think is important. This is the way we work in the dialogue, to get some, what could I call it, some feelings on the table which the patient has to tackle, and I have to tackle, and then we must see how we manage. The relation between, really, what happens just between us. <br />
  15. 15. Storiesabout irritation<br />15-10-2009<br />Annette Sofie Davidsen, MD, PhD adavid@sund.ku.dk<br />15<br />Tired of patients<br />Storiescreated by irritation<br />Not interested in hearingincoherentstories<br />To be honest I had actually become somewhat tired of her, so I simply could not stand it any more<br />
  16. 16. 15-10-2009<br />Annette Sofie Davidsen, MD, PhD adavid@sund.ku.dk<br />16<br />Family physician: Some can be enormously irritating. She made me – well, she was really irritating, unctuous, and would tell of all these horrible things she had – and how it hurt here and there. <br />Interviewer: but was that someone you could ask to tell her life story to get another view of her?<br />Family physician: no, she was too irritating, too peculiar. I’m damned if I think so. It must be some who – who you are somewhat interested in hearing about. I was not interested in hearing about her. <br />
  17. 17. Storiesaboutcategorization and biomedicalperspectives<br />15-10-2009<br />Annette Sofie Davidsen, MD, PhD adavid@sund.ku.dk<br />17<br />Muchshorter<br />About<br />Biomedical diagnoses<br />Prescription<br />Sickleave<br />Medical certificates<br />Reluctant to tell patient stories<br />Did not knowdetails<br />
  18. 18. Interpretation of results<br />15-10-2009<br />Annette Sofie Davidsen, MD, PhD adavid@sund.ku.dk<br />18<br />Familyphysicians have differenttheoreticalframes of reference for understanding patients<br />Differentconsultationstyles<br />Differentdiscourses of understanding<br />Different professional positioning<br />Manifests itselfthrough the style of narratives theytellabouttheir patients<br />The style is global and consistent<br />
  19. 19. Implications<br />15-10-2009<br />Annette Sofie Davidsen, MD, PhD adavid@sund.ku.dk<br />19<br />Training a narrative understandingcouldincreasefamilyphysicians’ psychologicalunderstanding of patients. <br />The conditions in familypracticearesuitable for this approach<br />
  20. 20. 15-10-2009<br />Annette Sofie Davidsen, MD, PhD adavid@sund.ku.dk<br />20<br />

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