‘I’m not sure if there is any point to all this doc?’: a qualitative study into GPs responses to existential questions

Alistair Appleby; John Swinton; Philip Wilson

doi:10.3399/bjgp18X697061

Abstract

Background Very few studies address how GPs react to situations where patients express doubt or perplexity about the meaning of their existence.

Aim To assess the range of responses which GPs make to a theoretical scenario, where a patient says ‘Doc, I’m not sure there is any point to all this?’. To discuss the significance of these responses within a clinical and philosophical context.

Method We interviewed 19 GPs in Scotland and analysed transcripts using an approach informed by grounded theory.

Results The context of these questions, patients’ other complaints, and the comfort of the GP in this area of discussion, affected the GP response. Responses included discomfort and diverting the conversation, exploring the contribution of physical pain, or, most commonly, considering the questioning to indicate mental health problems. Some GPs felt the questioning was fuelled by unmet emotional needs or by social and relational crises. GP responses included prescribing medication or pragmatic ‘just get on with it’ suggestions to the perceived unknowability of rational answers. Other GPs considered this represented a philosophical question worthy of legitimate debate and response, or with therapeutic potential.

Conclusion This raises questions about whether existential questioning, is best regarded as pathological, normative or potentially therapeutic. Our study indicates that GPs own philosophy and approach may define the scope of the discussion and therapeutic options. Consultations which permit legitimate existential discussion, while considering a wide range of health associations, generate the greatest range of therapeutic approaches, but further work on outcomes is justified.

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‘I’m not sure if there is any point to all this doc?’: a qualitative study into GPs responses to existential questions

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