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Licensed Unlicensed Requires Authentication Published by De Gruyter Mouton July 27, 2005

When talking to the patient is difficult: The physician's perspective

Elena Vegni, Sonia Visioli and Egidio A. Moja
From the journal


The aim of the study was to analyze the difficult doctor–patient relationship from a doctor's perspective. A qualitative–interpretative approach was employed to analyze representations of difficult visits collected by means of written narrations. Two main scenarios were identified: (i) a ‘personal scenario’ in which the doctor had difficulties from a purely personal perspective; and (ii) a ‘professional scenario’ in which the doctor had difficulties as a professional when the ‘other’ resists or in facing the ‘other’ who resists. A further scenario was identified in which problems were generated by the family of the patient. Results suggest that the relation between doctor and patient may be very complex. Difficulties may be internal to the doctor, hence intra-psychic, depending on being both a professional and a human being. Difficulties may also be external between two psychological subjects (labeled as inter-psychic), where interaction of the ‘you’ and the ‘other’ becomes a battleground, a wall of opposition, or alternatively a place of experimentation with relationships. Furthermore, external difficulties may also be between more than two persons (labeled as inter-personal), by the possible multiplicity of the ‘other’. This happens in particular when the ‘other’ is represented by the family.


Elena Vegni, M.A. (4-year degree in philosophy) is apsychologist. She is a research fellow at the Chair of Medical Psychology at the School of Medicine, University of Milan. She is a tutor of reference for the course on Health Communication, and senior tutor in CME workshops regardinghealth communication skills. Her research interests are in the field of health professional–patient relations, with both qualitative and quantitative approaches. Address for correspondence: Department of Medicine, Surgery and Dentistry, San Paolo Hospital, Via di Rudinì 8, Milan, I-20142 Italy.


Brown, J., Stewart, M., McCracken, E., McWhinney, I. R., and Levenstein, J. (1986). The patient-centered clinical method. 2. Definition and application. Family Practice3: 75–79.Search in Google Scholar

Engel, G. L. (1977). The need for a new medical model, a challenge for new medicine. Science196: 129–136.Search in Google Scholar

Flick, U. (1998). An Introduction to Qualitative Research. London: Sage Publications.Search in Google Scholar

Gadamer, H. G. (1960). Wahrheit und Methode: Grundzüge einer philosophischen Hermeneutik. Tübingen: Mohr.Search in Google Scholar

Glaser, B. and Strauss, A. (1967). The Discovery of Grounded Theory: Strategies for Qualitative Research. Chicago: Aldine.Search in Google Scholar

Heidegger, M. (1927). Sein und Zeit. Tübingen: Neomarius Verlag.Search in Google Scholar

Lowe, R., Schwartzman, J., Freeman, J., Quinn, L., and Zuckerman, S. (1998). Doctor talk and diabetes: Towards an analysis of the clinical construction of chronic illness. Social Science & Medicine47: 1267–1276.Search in Google Scholar

Meier, D. E., Back, A. L., and Morrison, R. S. (2001). The inner life of physicians and care of the seriously ill. Journal of the American Medical Association286: 3007–3014.Search in Google Scholar

Ong, L. M. L., De Haes, J. C. J. M., Hoos, A. M., and Lammes, F. B. (1995). Doctor–patient communication: A review of the literature. Social Science & Medicine40: 903–918.Search in Google Scholar

Pope, C., Ziebland, S., and Mays, N. (2000). Qualitative research in health care: Analysing qualitative data. British Medical Journal320: 114–116.Search in Google Scholar

Roter, D. (2000). The enduring and evolving nature of the patient–physician relationship. Patient Education and Counseling39: 5–15.Search in Google Scholar

Sarangi, S. (2001). On demarcating the space between lay expertise and expert laity. Text21: 3–13.Search in Google Scholar

Shaw, J. and Baker, M. (2004). ‘Expert patient’—dream or nightmare?British Medical Journal328: 723–724.10.1136/bmj.328.7442.723Search in Google Scholar

Stewart, M. (1995). Effective physician–patient communication and health outcomes: A review. Canadian Medical Association Journal152: 1423–1433.Search in Google Scholar

Strauss, A. and Corbin, J. (1990). Basics of Qualitative Research: Grounded Theory, Procedures and Techniques. Newbury Park, CA: Sage Publications.Search in Google Scholar

Svenaeus, F. (2003). Hermeneutics of medicine in the wake of Gadamer: The issue of phronesis. Theoretical Medicine24: 407–431.Search in Google Scholar

van den Brink-Muinen, A., Verhaak, P. F. M., Bensing, J. M., Bahrs, O., Deveugele, M., Gask, L., Leiva, F., Mead, N., Messerli, V., Oppizzi, L., Peltenburg, M., and Perez, A. (2000). Doctor–patient communication in different European health care systems: Relevance and performance from the patients' perspective. Patient Education and Counseling39: 115–127.Search in Google Scholar

Vegni, E., Zannini, L., Visioli, S., and Moja, E. A. (2001). Giving bad news: A GPs' narrative perspective. Supportive Care in Cancer9: 390–396.Search in Google Scholar

Vegni, E., Mauri, E., and Moja, E. A. (2004). Stories of doctors with patients in pain. A qualitative research on physicians' perspective. Supportive Care in Cancer.Search in Google Scholar

Williams, S., Weinman, J., Dale, J., and Newman, S. (1995). Patient expectations: What do primary care patients want from the GP and how far does meeting expectations affect patient satisfaction?Family Practice12: 193–201.10.1093/fampra/12.2.193Search in Google Scholar

Published Online: 2005-07-27
Published in Print: 2005-01-01

© by Walter de Gruyter Berlin New York

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