General practitioners’ relationship with preventive knowledge: a qualitative study
Géraldine Bloy A and Laurent Rigal B C D E F
+ Author Affiliations
- Author Affiliations
A LEDi, Université de Bourgogne, UMR CNRS 6307, INSERM U1200, Dijon, France.
B Department of General Practice, Sorbonne Paris Cité, Paris Descartes University, 24 rue du Fbg St Jacques, 75014 Paris, France.
C INSERM, Centre for Research in Epidemiology and Population Health, U1018, Gender, Health, Sexuality Team, 82 rue du Général Leclerc, 94276 Le Kremlin-Bicêtre, France.
D Paris Sud University, UMRS 1018, 15 Rue Georges Clemenceau, 91400 Orsay, France.
E INED, 133 Boulevard Davout, 75020 Paris, France.
F Corresponding author. Email: laurent.rigal@parisdescartes.fr
Australian Journal of Primary Health 22(5) 394-402 https://doi.org/10.1071/PY14133
Submitted: 7 September 2014 Accepted: 20 July 2015 Published: 9 September 2015
Abstract
General practitioners (GPs) do not provide enough preventive care. Nonetheless, without a detailed understanding of the logical processes that underlie their practices, it remains difficult to develop effective means of improvement. Their relationship to knowledge is one of three elements that strongly structure GPs’ preventive work (together with the doctor–patient relationship and the organisation of their professional space).The objective of this article was to explore the question of GPs’ relationship to knowledge about prevention. In 2010–2011, semi-directive interviews with a diverse sample of 100 GPs practising in the Paris metropolitan area were conducted. These interviews were coded according a reading grid that was developed collectively and analysed in the framework of grounded theory. The cognitive universe of GPs is neither homogeneous nor stable. It is composed of biomedical knowledge (delivered via guidelines, the professional press, opinion leaders and pharmaceutical companies), clinical knowledge (fed by individual situations from their daily experience and often conflicting with epidemiologic reasoning and data) and lay knowledge (from folk culture). Plunged into this complex cognitive universe that is difficult for them to master, doctors construct their own idiosyncratic preventive style by themselves, mostly in isolation. Two types of actions emerged as likely to help GPs better appropriate preventive knowledge: clarification of scientific data (especially from epidemiology and the social sciences) but also development of a collective analysis of the cognitive work required to integrate the different types of knowledge mobilised daily in their preventive practices.
Additional keywords: family practice, knowledge, prevention, qualitative research, screening.
References
Allen J, Gay B, Crebolder H, Heyrman J, Svab I, Ram P (2011) ‘The European definition of general practice / family medicine.’ (WONCA Europe: Barcelona)Armstrong D, Ogden J (2006) The role of etiquette and experimentation in explaining how doctors change behaviour: a qualitative study. Sociology of Health & Illness 28, 951–968.
Aronowitz R (1998) ‘Making sense of illness. Science, society and disease.’ (Cambridge University Press: Cambridge)
Asch SM, Kerr EA, Keesey J, Adams JL, Setodji CM, Malik S, McGlynn EA (2006) Who is at greatest risk for receiving poor-quality health care? The New England Journal of Medicine 354, 1147–1156.
| Who is at greatest risk for receiving poor-quality health care?Crossref | GoogleScholarGoogle Scholar | 1:CAS:528:DC%2BD28XisFemsrY%3D&md5=377537eee9e85695c68a9064e601a5ceCAS | 16540615PubMed |
Bachelard G (1984) ‘The new scientific spirit.’ (Beacon Press: Boston)
Beaulieu MD, Hudon E, Roberge D, Pineault R, Forte D, Legare J (1999) Practice guidelines for clinical prevention: do patients, physicians and experts share common ground? Canadian Medical Association Journal 161, 519–523.
Becker HS (1998) ‘Tricks of the trade: how to think about your research while you’re doing it.’ (University of Chicago Press: Chicago)
Becker HS, Geer B, Hughes EC, Strauss AL (1961) ‘Boys in white: student culture in medical school.’ (University of Chicago Press: Chicago)
Berg M (1995) Turning practice into a science: reconceptualizing postwar medical practice. Social Studies of Science 25, 437–476.
| Turning practice into a science: reconceptualizing postwar medical practice.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DC%2BD3MngsVSrtw%3D%3D&md5=9d1f25009e30f368752a492a5828b53dCAS | 1:STN:280:DC%2BD3MngsVSrtw%3D%3D&md5=9d1f25009e30f368752a492a5828b53dCAS | 11639797PubMed |
Berg M (1997) ‘Rationalizing medical work: decision-support techniques and medical practices.’ (the MIT Press: New Baskerville)
Bertaux D, Kohli M (1984) The life story approach: a continental view. Annual Review of Sociology 10, 215–237.
| The life story approach: a continental view.Crossref | GoogleScholarGoogle Scholar |
Blanquet M, Gerbaud L, Noirfalise C, Llorca PM, Campagne C, Malaval J (2011) Measuring preventive procedures by French GPs: an observational survey. The British Journal of General Practice 61, e31–e41.
| Measuring preventive procedures by French GPs: an observational survey.Crossref | GoogleScholarGoogle Scholar | 21401987PubMed |
Bloy G (2010) Que font les généralistes à la faculté? Analyse d’une implantation improbable. In ‘Singuliers généralistes. Sociologie de la médecine générale.’ (Eds G Bloy, F-X Schweyer) pp. 309–327. (EHESP: Rennes)
Bloy G, Rigal L (2013) With tact and measure? French doctors wrestling with the idea of assessing their medical practice [erratum published in Sociologie du Travail 2015; 57: e3]. Sociologie du Travail 55, e24–e47.
| With tact and measure? French doctors wrestling with the idea of assessing their medical practice [erratum published in Sociologie du Travail 2015; 57: e3].Crossref | GoogleScholarGoogle Scholar |
Bourgueil Y, Marek A, Mousquès J (2009) ‘Three models of primary care organisation in Europe, Canada, Australia and New-Zealand.’ (Irdes: Paris)
Carlsen B, Glenton C, Pope C (2007) Thou shalt versus thou shalt not: a meta-synthesis of GPs’ attitudes to clinical practice guidelines. The British Journal of General Practice 57, 971–978.
| Thou shalt versus thou shalt not: a meta-synthesis of GPs’ attitudes to clinical practice guidelines.Crossref | GoogleScholarGoogle Scholar | 18252073PubMed |
Chapple A, Ziebland S, Hewitson P, McPherson A (2008) What affects the uptake of screening for bowel cancer using a faecal occult blood test (FOBt): a qualitative study. Social Science & Medicine 66, 2425–2435.
| What affects the uptake of screening for bowel cancer using a faecal occult blood test (FOBt): a qualitative study.Crossref | GoogleScholarGoogle Scholar |
Davies G (1984) General practitioners and the pull of prevention. Sociology of Health & Illness 6, 267–289.
| General practitioners and the pull of prevention.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DyaL2M7mvVegug%3D%3D&md5=cac453ded14958138f55d8ecc5f93f2fCAS | 1:STN:280:DyaL2M7mvVegug%3D%3D&md5=cac453ded14958138f55d8ecc5f93f2fCAS |
Davison C, Davey Smith G, Frankel S (1991) Lay epidemiology and the prevention paradox: the implications of coronary candidacy for health education. Sociology of Health & Illness 13, 1–19.
| Lay epidemiology and the prevention paradox: the implications of coronary candidacy for health education.Crossref | GoogleScholarGoogle Scholar |
Demazière D, Dubar C (1997) ‘Analyser les entretiens biographiques.’ (Nathan: Paris)
Dodier N (1998) Clinical practice and procedures in Occupational Medicine: a study of the framing of individuals. In ‘Differences in medicine: unraveling practices, techniques and bodies.’ (Eds M Berg, A Mol.) pp. 53–85. (Duke University Press: Durham)
Dodier N, Barbot J (2008) Autonomy and objectivity as political operators in the medical world. Twenty years of public controversy about AIDS treatments in France. Science in Context 21, 403–434.
Duhamel G (1934) Les excès de l’étatisme et les responsabilités de la médecine. Revue des deux mondes 21, 277–299.
Engel GL (1977) The need for a new medical model: a challenge for biomedicine. Science 196, 129–136.
| The need for a new medical model: a challenge for biomedicine.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DyaE2s7ltVOmsA%3D%3D&md5=dfdd51a87cbd319227481c30b5f341fcCAS | 1:STN:280:DyaE2s7ltVOmsA%3D%3D&md5=dfdd51a87cbd319227481c30b5f341fcCAS | 847460PubMed | 847460PubMed |
Festinger L (1957) ‘A theory of cognitive dissonance.’ (Standford University Press: Standford)
Francke AL, Smit MC, de Veer AJ, Mistiaen P (2008) Factors influencing the implementation of clinical guidelines for health care professionals: a systematic meta-review. BMC Medical Informatics and Decision Making 8, 38
Freidson E (1970) ‘Profession of medicine: a study of the sociology of applied knowledge.’ (University of Chicago Press: Chicago)
Gabbay J, le May A (2004) Evidence based guidelines or collectively constructed “mindlines?” Ethnographic study of knowledge management in primary care. BMJ 329, 1013
| Evidence based guidelines or collectively constructed “mindlines?” Ethnographic study of knowledge management in primary care.Crossref | GoogleScholarGoogle Scholar | 15514347PubMed | 15514347PubMed |
Gaudillière J-P (2006) ‘La médecine et les sciences. XIXè–XXè siècles.’ (La Découverte: Paris)
Geneau R, Lehoux P, Pineault R, Lamarche P (2008) Understanding the work of general practitioners: a social science perspective on the context of medical decision making in primary care. BMC Family Practice 9, 12
| Understanding the work of general practitioners: a social science perspective on the context of medical decision making in primary care.Crossref | GoogleScholarGoogle Scholar | 18284700PubMed | 18284700PubMed |
Glaser B, Strauss AL (1967) ‘The discovery of Grounded Theory.’ (Aldine Press: London)
Gøtzsche CP (2012) ‘Mammography screening - truth, lies and controversy.’ (Radcliffe: London)
Grant S, Huby G, Watkins F, Checkland K, McDonald R, Davies H, Guthrie B (2009) The impact of pay-for-performance on professional boundaries in UK general practice: an ethnographic study. Sociology of Health & Illness 31, 229–245.
| The impact of pay-for-performance on professional boundaries in UK general practice: an ethnographic study.Crossref | GoogleScholarGoogle Scholar |
Greimas AJ (1987 [1970]) ‘On meaning.’ (University of Minnesota Press: Minneapolis)
Haines A, Donald A (1998) ‘Getting research into practice.’ (BMJ Books: London)
Hardy A-C (2013) ‘Travailler à guérir. Sociologie de l’objet du travail médical.’ (EHESP: Rennes)
Helman CG (1978) “Feed a cold, starve a fever”–folk models of infection in an English suburban community, and their relation to medical treatment. Culture, Medicine and Psychiatry 2, 107–137.
| “Feed a cold, starve a fever”–folk models of infection in an English suburban community, and their relation to medical treatment.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DyaE1M%2FksVOhsw%3D%3D&md5=73273a328f93874a0f56c9254fbdbb51CAS |
Herzlich C (1973) ‘Health and illness. A social-psychological analysis.’ (London Academic Press: London)
Krumeich A, Weijts W, Reddy P, Meijer-Weitz A (2001) The benefits of anthropological approaches for health promotion research and practice. Health Education Research 16, 121–130.
| The benefits of anthropological approaches for health promotion research and practice.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DC%2BD3M3kvFyhug%3D%3D&md5=1a988837d7d77aad923d64d9235413f1CAS | 1:STN:280:DC%2BD3M3kvFyhug%3D%3D&md5=1a988837d7d77aad923d64d9235413f1CAS | 11345657PubMed | 11345657PubMed |
Levi Strauss C (1966) ‘The savage mind.’ (University of Chicago Press: Chicago)
Lock M (1982) Models and practice in medicine: menopause as syndrome or life transition. Culture, Medicine and Psychiatry 6, 261–280.
| Models and practice in medicine: menopause as syndrome or life transition.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DyaL3s%2FnvVamtA%3D%3D&md5=b9e00248a76da4a09d3b928b05783926CAS | 1:STN:280:DyaL3s%2FnvVamtA%3D%3D&md5=b9e00248a76da4a09d3b928b05783926CAS | 7172713PubMed | 7172713PubMed |
Lock M, Nguyen V-K (2010) ‘An anthropology of biomedicine.’ (Wiley-Blackwell: Oxford)
Lorant V, Boland B, Humblet P, Deliege D (2002) Equity in prevention and health care. Journal of Epidemiology and Community Health 56, 510–516.
| Equity in prevention and health care.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DC%2BD38zmvVWhtA%3D%3D&md5=75816b409d3e8089dd46663a88cf2c54CAS | 12080158PubMed | 12080158PubMed |
Marks H (1997) ‘The progress of experiment: science and therapeutic reform in the United States, 1900–1990.’ (Cambridge University Press: Cambridge)
McDonald R, Harrison S, Checkland K, Campbell SM, Roland M (2007) Impact of financial incentives on clinical autonomy and internal motivation in primary care: ethnographic study. BMJ 334, 1357
| Impact of financial incentives on clinical autonomy and internal motivation in primary care: ethnographic study.Crossref | GoogleScholarGoogle Scholar | 17580318PubMed | 17580318PubMed |
Pardell H, Roure E, Drygas W, Morava E, Nussel E, Puska P, Uhanov M, Laaksonen M, Tresserras R, Salto E, Salleras L (2001) East-west differences in reported preventive practices. A comparative study of six European areas of the WHO-CINDI programme. European Journal of Public Health 11, 393–396.
| East-west differences in reported preventive practices. A comparative study of six European areas of the WHO-CINDI programme.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DC%2BD38%2FjvFGhsA%3D%3D&md5=0f2780502c0422d49d3f438fdb87af76CAS | 11766479PubMed | 11766479PubMed |
Pelletier-Fleury N, Le Vaillant M, Hebbrecht G, Boisnault P (2007) Determinants of preventive services in general practice. A multilevel approach in cardiovascular domain and vaccination in France. Health Policy 81, 218–227.
| Determinants of preventive services in general practice. A multilevel approach in cardiovascular domain and vaccination in France.Crossref | GoogleScholarGoogle Scholar | 16884815PubMed | 16884815PubMed |
Pham HH, Schrag D, Hargraves JL, Bach PB (2005) Delivery of preventive services to older adults by primary care physicians. Journal of the American Medical Association 294, 473–481.
| Delivery of preventive services to older adults by primary care physicians.Crossref | GoogleScholarGoogle Scholar | 1:CAS:528:DC%2BD2MXms1ygsbs%3D&md5=c21ab3065bc3fd565c815808cd0434a4CAS | 16046654PubMed | 16046654PubMed |
Rosman S (2010) Les pratiques de prescription des médecins généralistes. Une étude sociologique comparative entre la France et les Pays-Bas. In ‘Singuliers généralistes. Sociologie de la médecine générale.’ (Eds G Bloy, F-X Schweyer) pp. 117–131. (EHESP: Rennes)
Sackett DL, Rosenberg WM, Gray JA, Haynes RB, Richardson WS (1996) Evidence based medicine: what it is and what it isn’t. BMJ 312, 71–72.
| Evidence based medicine: what it is and what it isn’t.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DyaK287ktF2itw%3D%3D&md5=358b5312bf01b017cce14aaadd61c8d8CAS | 8555924PubMed | 8555924PubMed |
Scheper-Hughes N, Lock M (1987) The “mindful body”: a prolegomenon to future work in medical anthropology. Medical Anthropology Quarterly 1, 1–36.
Schoen C, Osborn R, Doty MM, Squires D, Peugh J, Applebaum S (2009) A survey of primary care physicians in eleven countries, 2009: perspectives on care, costs, and experiences. Health Affairs (Millwood) 28, w1171–w1183.
| A survey of primary care physicians in eleven countries, 2009: perspectives on care, costs, and experiences.Crossref | GoogleScholarGoogle Scholar | 19884491PubMed | 19884491PubMed |
Schön D (1983) ‘The reflective practitioner: how professionals think in action.’ (Temple Smith: London)
Schweyer F-X (2010) Activités et pratiques des médecins généralistes. In ‘Singuliers généralistes. Sociologie de la médecine générale.’ (Eds G Bloy, F-X Schweyer) pp. 55–74. (EHESP: Rennes)
Stange KC, Flocke SA, Goodwin MA, Kelly RB, Zyzanski SJ (2000) Direct observation of rates of preventive service delivery in community family practice. Preventive Medicine 31, 167–176.
| Direct observation of rates of preventive service delivery in community family practice.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DC%2BD3cvmtVentA%3D%3D&md5=557dd72543e20db6280949fde382db79CAS | 10938218PubMed | 10938218PubMed |
Starfield B, Shi L, Macinko J (2005) Contribution of primary care to health systems and health. The Milbank Quarterly 83, 457–502.
| Contribution of primary care to health systems and health.Crossref | GoogleScholarGoogle Scholar | 16202000PubMed | 16202000PubMed |
Trinder L, Reynolds S (2000) ‘Evidence-based practice: a critical appraisal.’ (Blackwell Science: Oxford)
van Doorslaer E, Masseria C, Koolman X (2006) Inequalities in access to medical care by income in developed countries. Canadian Medical Association Journal 174, 177–183.
| Inequalities in access to medical care by income in developed countries.Crossref | GoogleScholarGoogle Scholar | 16415462PubMed | 16415462PubMed |
van Ryn M, Burke J (2000) The effect of patient race and socio-economic status on physicians’ perceptions of patients. Social Science & Medicine 50, 813–828.
| The effect of patient race and socio-economic status on physicians’ perceptions of patients.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DC%2BD3c7lvVGhtA%3D%3D&md5=4fce79cafa75efe72ca42782e6b1a10eCAS | 1:STN:280:DC%2BD3c7lvVGhtA%3D%3D&md5=4fce79cafa75efe72ca42782e6b1a10eCAS |
Williams A, Boulton M (1988) Thinking prevention: concepts and constructs in general practice. In ‘Biomedicine examined.’ (Eds M Lock, DR Gordons) pp. 227–255. (Kluwer Academic Publishers: Dordrecht)
Williams SJ, Calnan M (1994) Perspectives on prevention: the views of general practitioners. Sociology of Health & Illness 16, 372–393.
| Perspectives on prevention: the views of general practitioners.Crossref | GoogleScholarGoogle Scholar |
Wilson JMG, Jungner G (1968) Principles and practice of screening for disease. WHO, Geneva.
