Role ambiguity in general practice: the care of patients dying at home

Abstract

Semi-structured interviews were given to 22 GPs to investigate their perceptions and strategies when dealing with dying patients. There seemed no clear division in practice between policies of telling and not telling patients about their illness. Most patients find out eventually, but GPs differ in the extent to which they aim for open discussions of the matter. Over half perceived care of the dying as a demanding but satisfying fulfillment of their professional skills, but nearly a quarter found it difficult and with few compensating rewards. We conclude that while there is a well established ideal type corresponding to the curative role, there is another which is still in the process of development. This type generates a role for doctors which parallels the patient's dying role, as distinct from the sick role.

KIE: Twenty-two British general practitioners were given semi-structured interviews to investigate their perceptions and strategies when dealing with dying patients. On the question of telling patients about the nature of their illnesses, there appeared to be a continuum, rather than a dichotomy, of practice--most patients learn the information eventually, but physicians differ in the extent to which they aim for open discussion of the issue. Over half of the physicians perceived terminal care to be a demanding but satisfying fulfillment of their professional skills. Nearly a quarter, however, found it both difficult and unrewarding. The authors suggest that such physicians are guided by only a curative role model and have not yet succeeded in internalizing a developing role model for dealing with dying patients.