Engagement with emotional concerns in general practice: thematic analysis of GP consultations

Abstract

BackgroundEmotional concerns (defined as any expression of low mood, anxiety or psychosocial stress) are an important part of the biopsychosocial care model used in modern medical practice. Previous work has demonstrated variable engagement with emotional concerns and that improved communication has been associated with reductions in emotional distress.AimTo examine how emotional concerns are engaged with during routine GP consultations.Design and SettingSecondary study using the HARI database. The available dataset contains 231 recordings from 10 GPs across 8 urban and suburban practices recorded in 2017 and 2018.MethodThe dataset was reviewed to identify any consultations containing emotional concerns (as defined as any expression of low mood, anxiety or psychosocial stress) before being imported into NVivo 12 to facilitate thematic analysis and coding. Reflexive inductive thematic analysis resulted in two major themes.ResultsEngagement with emotional concerns is dynamic throughout consultations (Theme 1). This dynamism relates to competing areas of focus, immediate versus delayed engagement and re-iteration of concerns throughout consultations. Emotional concerns can be engaged with in a similar way to physical concerns (Theme 2) using a diagnostic and treatment-based approach, however in addition to this therapeutic listening and conversation is utilised.ConclusionAwareness of the dynamic nature of emotional concerns within consultations and encouraging engagement with concerns in a flexible and patient-oriented manner may help improve doctor-patient communication. In addition, investigating how GPs and patients build shared understanding around emotional concerns may identify methods to reduce patients’ emotional distress.