Teoría en la acción sobre la relación con el paciente. Una perspectiva diferente de representar y entender el comportamiento del médico de familia en la consulta / Theory of action on patient relationships. A different way of representing and understanding the behaviour of the family doctor in the clinic

OBJETIVO: Identificar la teoría en la acción según el concepto de Argyris y Schon de un grupo de médicos de familia y comprobar si esta «teoría» aparece como una representación válida de su comportamiento y congruente con otros estudios. DISEÑO: Descriptivo transversal. Emplazamiento: Atención Primaria. PARTICIPANTES: Diez médicos de familia con una experiencia mínima de 10 años de otros tantos centros de salud de una ciudad y su comarca. MÉTODO: Selección por muestreo intencional en función de la antigüedad, sexo, características del centro de referencia y estilo de práctica. Grabación y trascripción de audiograbaciones y observación de consultas. Formulación y agrupación inductiva de las proposiciones a partir de la identificación de las conductas en la consulta y su contexto siguiendo las propuestas de Argyris y Schon.comparación de las proposiciones de los participantes entre sí y con la literatura. Resultados y DISCUSIÓN: Las 84 proposiciones de los entrevistados se agrupan en 9 categorías temáticas que en orden del peso de su presencia son: confianza/interés, medicalización, dimensión subjetiva, dirección, negociación, distancia e información, calidad clínica, comunicación clínica. Las proposiciones de los dos primeros temas son básicamente coincidentes mientras que en el resto aparecen diferencias en la teoría en la acción de distintos médicos. Las proposiciones pueden ser integradas con los resultados de otros estudios. CONCLUSIÓN: Es factible formular la teoría en la acción de los MF que aparece como una representación global y coherente de su comportamiento en la consulta

OBJECTIVE: To identify the «theory in the action», according to the concept of Argyris and Schon, in a group of Family Doctors and to examine whether this theory seems to be a valid representation of their behaviour, as well as a comparison with results of other studies. DESIGN: Descriptive, cross-sectional study. SETTING: Primary Care. PARTICIPANTS: Ten Family Doctors with a minimum of 10 years experience in Health Centres of a city and its surrounding area. Method: Intentional sampling was used to select the participants, according to age, sex, characteristics of the Health Centre, and style of practice style. Data was collected from recordings and transcription of self-recordings, as well as from observations in the consulting room. Inductive formulation and grouping of the propositions was performed from the identification of the behaviours in the consulting room and as well as their context following the proposals of Argyris and Schon. A comparison was also made of the propositions of the participants of this study and with those in the literature. Results and DISCUSSION: The 84 propositions from the interviews were grouped into 9 topical categories, which in order of weight were: confidence / interest, prescribing medications, subjective dimension, direction, negotiation, distance, and information. The propositions of the first two topics are basically similar, while differences appear in the theory in action of various doctors. The propositions were comparable with the results of other studies. CONCLUSIONS: It is possible to formulate the theory in action of Family Doctors that appears to be an overall and coherent representation of their behaviour in the consulting room

[Theory of action on patient relationships. A different way of representing and understanding the behaviour of the family doctor in the clinic]. / Teoría en la acción sobre la relación con el paciente. Una perspectiva diferente de representar y entender el comportamiento del médico de familia en la consulta.

OBJECTIVE: To identify the «theory in the action¼, according to the concept of Argyris and Schon, in a group of Family Doctors and to examine whether this «theory¼ seems to be a valid representation of their behaviour, as well as a comparison with results of other studies. DESIGN: Descriptive, cross-sectional study. SETTING: Primary Care. PARTICIPANTS: Ten Family Doctors with a minimum of 10 years experience in Health Centres of a city and its surrounding area. METHOD: Intentional sampling was used to select the participants, according to age, sex, characteristics of the Health Centre, and style of practice style. Data was collected from recordings and transcription of self-recordings, as well as from observations in the consulting room. Inductive formulation and grouping of the propositions was performed from the identification of the behaviours in the consulting room and as well as their context following the proposals of Argyris and Schon. A comparison was also made of the propositions of the participants of this study and with those in the literature. RESULTS AND DISCUSSION: The 84 propositions from the interviews were grouped into 9 topical categories, which in order of weight were: confidence / interest, prescribing medications, subjective dimension, direction, negotiation, distance, and information. The propositions of the first two topics are basically similar, while differences appear in the «theory in action¼ of various doctors. The propositions were comparable with the results of other studies. CONCLUSION: It is possible to formulate the theory in action of Family Doctors that appears to be an overall and coherent representation of their behaviour in the consulting room.

[Stated theory of family doctors on their relationships with patients]. / Teoría declarada de los médicos de familia sobre la relación con el paciente.

OBJECTIVE: To identify and analyse the "theory" expressed by family doctors on the essential features of an effective and functional doctor-patient relationship and on how to achieve one ("stated theory" of Argyris and Schon). DESIGN: Qualitative, based on discourse analysis. SETTING: Primary care. METHOD: Interviews recorded with 10 family doctors selected by intentional sampling that were then transcribed. The propositions in the discourses were identified and conceptual maps were constructed. An inductive analysis classified the questions and positions that emerged and identified similarities and differences between subjects. RESULTS: Confidence and absence of conflict were the main desirable features of the doctor-patient relationship. Patients with a "demanding" attitude and their dishonesty were the most quoted obstacles. Doctors accepted negotiation, but held a very limited view of patient participation. Differences were appreciated on distance, the biomedical versus psychosocial focus and health education. Doctors' communication skills and qualities were little cited. Technical terminology in this area appeared little in the discourses. CONCLUSIONS: Discourses highlighted "health consumerism" and revealed disagreements on distance in the relationship and the psycho-social approach. These points, which should be prioritised in training, along with education, can serve to define family doctors distinct professional orientations. Training methodology must bear in mind that experience dominates "stated theory" in this area.

Teoría declarada de los médicos de familia sobre la relación con el paciente / Stated theory of family doctors on their relationships with patients

Objetivo. Identificar y analizar cuál es la «teoría» que los médicos de familia expresan sobre las características esenciales de la relación médico-paciente efectiva y funcional y sobre cómo alcanzarla («teoría declarada» de Argyris y Schon). Diseño. Cualitativo, basado en análisis de discursos. Emplazamiento. Atención primaria. Método. Entrevistas audiograbadas a 10 médicos de familia seleccionados por muestreo intencional que fueron transcritas. Se identificaron las proposiciones de los discursos y se construyeron mapas conceptuales. Se realizó un análisis inductivo mediante la categorización de los temas y posiciones aparecidos, y la identificación de similitudes y diferencias intersujetos. Resultados. La confianza y la ausencia de conflictos son las principales características deseables de la relación médico-paciente. La actitud «demandante» y la deshonestidad de los pacientes son los obstáculos más citados. Se acepta la negociación pero se mantiene una visión muy limitada de la participación del paciente. Se aprecian diferencias en la distancia, el foco biomédico frente a psicosocial y en la educación sanitaria. Las habilidades de comunicación y las cualidades del médico son poco citadas. La terminología técnica en esta área aparece poco en los discursos. Conclusiones. Los discursos resaltan el «consumismo sanitario» y descubren desacuerdos sobre la distancia en la relación y el abordaje psicosocial. Estos puntos, que deben ser priorizados en la formación, junto con la educación, pueden servir para definir distintas orientaciones profesionales de los médicos de familia. La metodología de la formación debe tener en cuenta que la experiencia domina en la «teoría declarada» en esta área

Objective. To identify and analyse the "theory" expressed by family doctors on the essential features of an effective and functional doctor-patient relationship and on how to achieve one ("stated theory" of Argyris and Schon). Design. Qualitative, based on discourse analysis. Setting. Primary care. Method. Interviews recorded with 10 family doctors selected by intentional sampling that were then transcribed. The propositions in the discourses were identified and conceptual maps were constructed. An inductive analysis classified the questions and positions that emerged and identified similarities and differences between subjects. Results. Confidence and absence of conflict were the main desirable features of the doctor-patient relationship. Patients with a "demanding" attitude and their dishonesty were the most quoted obstacles. Doctors accepted negotiation, but held a very limited view of patient participation. Differences were appreciated on distance, the biomedical versus psychosocial focus and health education. Doctors' communication skills and qualities were little cited. Technical terminology in this area appeared little in the discourses. Conclusions. Discourses highlighted "health consumerism" and revealed disagreements on distance in the relationship and the psycho-social approach. These points, which should be prioritised in training, along with education, can serve to define family doctors´ distinct professional orientations. Training methodology must bear in mind that experience dominates "stated theory" in this area