Skip to main content

Main menu

  • HOME
  • ONLINE FIRST
  • CURRENT ISSUE
  • ALL ISSUES
  • AUTHORS & REVIEWERS
  • SUBSCRIBE
  • RESOURCES
    • About BJGP
    • Conference
    • Advertising
    • BJGP Life
    • eLetters
    • Librarian information
    • Alerts
    • Resilience
    • Video
    • Audio
    • COVID-19 Clinical Solutions
  • RCGP
    • BJGP for RCGP members
    • BJGP Open
    • RCGP eLearning
    • InnovAIT Journal
    • Jobs and careers
    • RCGP e-Portfolio

User menu

  • Subscriptions
  • Alerts
  • Log in

Search

  • Advanced search
British Journal of General Practice
  • RCGP
    • BJGP for RCGP members
    • BJGP Open
    • RCGP eLearning
    • InnovAIT Journal
    • Jobs and careers
    • RCGP e-Portfolio
  • Subscriptions
  • Alerts
  • Log in
  • Follow bjgp on Twitter
  • Visit bjgp on Facebook
  • Blog
  • Listen to BJGP podcast
Advertisement
British Journal of General Practice

Advanced Search

  • HOME
  • ONLINE FIRST
  • CURRENT ISSUE
  • ALL ISSUES
  • AUTHORS & REVIEWERS
  • SUBSCRIBE
  • RESOURCES
    • About BJGP
    • Conference
    • Advertising
    • BJGP Life
    • eLetters
    • Librarian information
    • Alerts
    • Resilience
    • Video
    • Audio
    • COVID-19 Clinical Solutions
Out of Hours

Viewpoint: Redundant subjectivity?

Stephen Pattison
British Journal of General Practice 2017; 67 (657): 170. DOI: https://doi.org/10.3399/bjgp17X690257
Stephen Pattison
Professor of Religion, Ethics and Practice, University of Birmingham, Birmingham.
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
  • Article
  • Figures & Data
  • Info
  • eLetters
  • PDF
Loading
Figure1

I actively avoid going to my GP. One who ‘should know better’, over the years I have developed an increasing aversion to visiting the hard-working souls charged with my primary care. At the heart of this, I think, is the feeling that my subjectivity is now redundant and disregarded.

I go to the GP with a small number of problems, important to me, but apparently insignificant to them. Instead of attending to my concerns, the GP, gazing first at a computer screen, and then, driven perhaps by prompts and advice from government and other health bodies, takes my blood pressure and interrogates me on my lifestyle before giving me unsought advice about living a healthier life (as if I didn’t know that I could do that, and were not ashamed of the fact that I don’t). I leave the surgery officially edified, but feeling unheard, guilty, and demoralised.

My psychotherapist partner has become hypothyroid, a condition she was warned years ago that she might develop. She contemplated relinquishing her flourishing practice as she could not think. The GP’s response: the blood tests show that you are within normal range, so we are not going to do anything about it. But you seem depressed, so why don’t we give you a mental health plan and refer you to psychiatric services?

My partner knows the difference between depression and physical depletion. This counts for little before the statistics and external guidance that have captured the GP’s judgement and prescription pad.

Strangely, if you go to the doctor saying you feel low, you can be administered heavy-duty psychoactive drugs without recourse to any physical tests whatsoever. So sometimes the patient’s subjective experience ‘trumps’ all other information. Sometimes it is irrelevant, however lousy the patient feels, however close to some statistical borderline they are, and however cheap the putative treatment.

I write in a spirit of perplexed solidarity with GPs. My perplexity revolves around the fluctuating currency of subjectivity in illness and clinical encounters, the value of different kinds of evidence, and the nature of doctors’ role in a context of ever more, and better, information and testing.

Regarding the changing value of subjectivity in illness and clinical encounters, until patients and doctors model themselves on machines, behaving consistently and predictably, subjectivity is unavoidable. If ignored, it will obtrude; patients will become uncollaborative, angry, or any number of other unhelpful, distressing things. This will be painful within doctors’ own subjectivities. And surely doctors’ own varied, needful persons are not just an unhelpful contaminant, perverting the course of clinical investigation?

The patient–doctor relationship, complex and contextual, requires many different kinds of evidence to achieve mutually satisfactory outcomes. What is statistically true for the population generally may not be so for individuals. Scientifically derived information is, at best, only half of the needed information. Other narratives and data are important; especially to patients themselves.

So to the role of GPs. Perhaps in someone’s mind the aim is to make humans redundant in medical encounters so we can self-diagnose and treat with computers and sampling kits. But is it not GPs’ job, skill, and satisfaction to mediate between varied data and facts and the subjectivity of patients, to attain a satisfactory outcome by which patients engage more fully with their lives?

I have heard senior doctors in the RCGP argue for this skilful, mutually rewarding approach. It would be much appreciated by patients, and it is not a reality in all local practices. Trust depends on attending to people and their concerns. GPs, please take our subjectivities seriously: we are stuck with them. If you don’t, your capacity to deliver on ‘evidence-driven’ targets may be threatened by our avoidance and non-cooperation. The sources of guidance, protocols, and targets need to recognise that doctors and patients have awkward, delightful subjectivities so that we might enjoy happier, healthier professional relationships. Who knows, maybe the outcomes of encounters that take subjectivity seriously may be cheaper and more effective in the long run?

  • © British Journal of General Practice 2017
View Abstract
Back to top
Previous ArticleNext Article

In this issue

British Journal of General Practice: 67 (657)
British Journal of General Practice
Vol. 67, Issue 657
April 2017
  • Table of Contents
  • Index by author
Download PDF
Download PowerPoint
Article Alerts
Or,
sign in or create an account with your email address
Email Article

Thank you for recommending British Journal of General Practice.

NOTE: We only request your email address so that the person to whom you are recommending the page knows that you wanted them to see it, and that it is not junk mail. We do not capture any email address.

Enter multiple addresses on separate lines or separate them with commas.
Viewpoint: Redundant subjectivity?
(Your Name) has forwarded a page to you from British Journal of General Practice
(Your Name) thought you would like to see this page from British Journal of General Practice.
CAPTCHA
This question is for testing whether or not you are a human visitor and to prevent automated spam submissions.
Citation Tools
Viewpoint: Redundant subjectivity?
Stephen Pattison
British Journal of General Practice 2017; 67 (657): 170. DOI: 10.3399/bjgp17X690257

Citation Manager Formats

  • BibTeX
  • Bookends
  • EasyBib
  • EndNote (tagged)
  • EndNote 8 (xml)
  • Medlars
  • Mendeley
  • Papers
  • RefWorks Tagged
  • Ref Manager
  • RIS
  • Zotero

Share
Viewpoint: Redundant subjectivity?
Stephen Pattison
British Journal of General Practice 2017; 67 (657): 170. DOI: 10.3399/bjgp17X690257
del.icio.us logo Digg logo Reddit logo Twitter logo CiteULike logo Facebook logo Google logo Mendeley logo
  • Tweet Widget
  • Facebook Like
  • Google Plus One
  • Mendeley logo Mendeley

Jump to section

  • Top
  • Article
  • Figures & Data
  • Info
  • eLetters
  • PDF

More in this TOC Section

  • Fakery and science
  • Books: A Layman’s Guide to Psychiatry and Psychoanalysis
Show more Out of Hours

Related Articles

Cited By...

Advertisement

BJGP Life

BJGP Open

 

@BJGPjournal's Likes on Twitter

 
 

British Journal of General Practice

NAVIGATE

  • Home
  • Current Issue
  • All Issues
  • Online First
  • Authors & reviewers

RCGP

  • BJGP for RCGP members
  • BJGP Open
  • RCGP eLearning
  • InnovAiT Journal
  • Jobs and careers
  • RCGP e-Portfolio

MY ACCOUNT

  • RCGP members' login
  • Subscriber login
  • Activate subscription
  • Terms and conditions

NEWS AND UPDATES

  • About BJGP
  • Alerts
  • RSS feeds
  • Facebook
  • Twitter

AUTHORS & REVIEWERS

  • Submit an article
  • Writing for BJGP: research
  • Writing for BJGP: other sections
  • BJGP editorial process & policies
  • BJGP ethical guidelines
  • Peer review for BJGP

CUSTOMER SERVICES

  • Advertising
  • Contact subscription agent
  • Copyright
  • Librarian information

CONTRIBUTE

  • BJGP Life
  • eLetters
  • Feedback

CONTACT US

BJGP Journal Office
RCGP
30 Euston Square
London NW1 2FB
Tel: +44 (0)20 3188 7679
Email: journal@rcgp.org.uk

British Journal of General Practice is an editorially-independent publication of the Royal College of General Practitioners
© 2021 British Journal of General Practice

Print ISSN: 0960-1643
Online ISSN: 1478-5242