Personal investment: Five physicians' core experience of relating with patients

Studies examining how physicians experience medical practice have focused on specific elements of their experience, such as satisfaction and frustration. Researchers have identified and tested a number of discrete variables that were presumably related to doctors' experience of providing medical care. The results of these studies have been largely descriptive, lacking an in-depth understanding of what the variables mean, why they are important determinants of the experience of being a physician, and how they are connected to one another. The objective of this investigation was to arrive at a comprehensive understanding of doctors' subjective conceptualization of their work, perception of their experiences, and impact of these experiences. To meet these objectives, open-ended interviews were conducted with five physicians (general practice and family practice doctors) individually. The findings are based on an in-depth analysis of these interviews. The interviews were audiotaped and later transcribed verbatim. The investigator also kept a written record of any observations and thoughts regarding the participants and the circumstances surrounding the interviews. Using the procedures of the grounded theory method interpreted as methodical hermeneutics, a qualitative analysis of the transcripts was performed. Also, throughout the course of the analysis guidance and feedback from committee members provided an external audit, helping to ensure that interpretations of the text were reasonable, comprehensive, and grounded in the accounts.

The emergent representation of the phenomenon consists of a five-level hierarchical category structure. The analysis began with the conceptualization of 132 initial categories and it evolved into two main categories and a core category that collegiate the lower-order categories. The core category was labeled Personal Investment and the two main categories it subsumes were named Intensely Personal Experience and Value of Trust. These higher-order categories and those they subsume represent the main understanding to emerge from the study, which is that physicians were intensely and personally involved in their work. They were engaged with their patients, committed to caring for their medical needs, and invested in the outcomes. Although their personal investment in medical care delivery was manifested throughout the accounts of all participants, there were considerable differences between how it was experienced by each of them. Thus, although all physicians were deeply affected by their work, they also had individualistic reactions to delivering medical care. Implications for research into and the experience of medical practice are discussed.