Does the achievement of medical identity limit the ability of primary care practitioners to be patient-centred? A qualitative study.

OBJECTIVE: To explore primary care practitioners approach to and management of menstrual disorders using a sociological perspective.
METHODS: Semi-structured interviews of primary care practitioners with an iterative approach to recruitment and analysis informed by grounded theory.
RESULTS: Two broad approaches to patient care were described-a biomedical approach, which concentrated on medical history taking and the search for disease, and a patient-as-person approach where a patient's individual ideas and concerns were elicited. Practitioners believed they had a role in integrating these approaches. Activities intrinsic to the biomedical approach such as the performance of examinations, the ordering of tests and making decisions about biomedical aspects of care were however not available for shared decision-making. The exercise of these decisions by medical practitioners was necessary for them to achieve their professional identity.
CONCLUSION: While practitioners accepted the ideology of patient-centred care the biomedical approach had the advantage of providing practitioners with a professional identity, which protected their status in relation to patients and colleagues. PRACTICE IMPLICATIONS: The adoption of shared decision-making by medically qualified primary care practitioners is limited by practitioners need to achieve their medical identity. At present, this identity does not involve significant sharing of power and responsibility. A shift in perception of medical identity is required before more shared decision-making is seen in practice.