Different narratives in different

doctor-patient relationships

1 Annette Sofie Davidsen, MD, PhD 12/08/2021

adavid@sund.ku.dk
Family practice

 Carachterized by:

 All sorts of problems

 Great part of workload is made up of mental disorder
 Long-extended knowledge of patients
 Knowledge of illness story and family story

2 Annette Sofie Davidsen, MD, PhD 12/08/2021

adavid@sund.ku.dk
Aim of study

 To explore which narratives family physicians told about

patients with psychological problems or mental disorder

3 Annette Sofie Davidsen, MD, PhD 12/08/2021

adavid@sund.ku.dk
Narratives
 Increasing interest in narratives across many disciplines
since the 1980s
 The ’narrative turn’

4 Annette Sofie Davidsen, MD, PhD 12/08/2021

adavid@sund.ku.dk
The ’narrative turn’
 In psychology

 Bruner, J. (1986). Actual Minds, Possible Worlds. Cambridge,

Mass.: Harvard University Press.
 Bruner, J. (1990). Acts of Meaning. Cambridge, Mass.: Harvard
University Press.
 Sarbin, T. R. (1986). Narrative psychology, the storied nature
of human conduct. New York: Praeger.
 Polkinghorne, D. E. (1988). Narrative Knowing and the Human
Sciences. Albany, N.Y.: State University of New York Press.

5 Annette Sofie Davidsen, MD, PhD 12/08/2021

adavid@sund.ku.dk
The ’narrative turn’
 In psychotherapy

 Schafer, R. (1980). Narration in the Psychoanalytic Dialog. Critical

Inquiry, 7, 29-53.
 Spence, D. P. (1982). Narrative Truth and Theoretical Truth.
Psychoanalytic Quarterly, 51, 43-69.
 Angus, L. & Kagan, F. (2007). Empathic Relational Bonds and Personal
Agency in Psychotherapy: Implications for Psychotherapy Supervision,
Practice, and Research. Psychotherapy:Theory, Research, Practice and
Training, 44, 371-377.
 McLeod, J. (1999). A narrative social constructionist approach to
therapeutic empathy. Counselling Psychotherapy Quarterly, 12, 377-394.
 Schafer, R. (1992). Retelling a life: Narration and Dialogue in
Psychoanalysis. New York: Basic Books.

6 Annette Sofie Davidsen, MD, PhD 12/08/2021

adavid@sund.ku.dk
The therapist is never a neutral mirror
 The story is always created in an interplay between
therapist and patient

 In psychotherapy
 and
 In family practice

7 Annette Sofie Davidsen, MD, PhD 12/08/2021

adavid@sund.ku.dk
 Consultations in family practice contain many
psychotherapeutic elements

8 Annette Sofie Davidsen, MD, PhD 12/08/2021

adavid@sund.ku.dk
Method

 In-depth semi-structured interviews with 14 family

physicians
 Invited to tell patient stories
 Narrative analysis of interviews
 Descriptive
 Interpretive

9 Annette Sofie Davidsen, MD, PhD 12/08/2021

adavid@sund.ku.dk
Results
 Different participants told completely different stories
 Different themes
 Different narrative styles

 Four types
 Stories with detailed description of patients’ situation
 Stories about emotions and relationships
 Stories about irritation
 Stories about categorization and biomedical perspectives

10 Annette Sofie Davidsen, MD, PhD 12/08/2021

adavid@sund.ku.dk
 Each participant told the same type of narrative
– the same narrative style –
through the entire interview

11 Annette Sofie Davidsen, MD, PhD 12/08/2021

adavid@sund.ku.dk
Stories with detailed description of
patients’ situation

 Easy and natural to tell stories

 Detailed stories
 Deep knowledge
 Own reflections
 Engagement

12 Annette Sofie Davidsen, MD, PhD 12/08/2021

adavid@sund.ku.dk
I think it’s fantastic, to deal with different life
stories, and to relate them to the their present
lives, well, also the broadness you have as a
family physician, children, wives and husbands
and – well it’s a fantastic approach. And it’s a
fantastic knowledge you possess.

13 Annette Sofie Davidsen, MD, PhD 12/08/2021

adavid@sund.ku.dk
Stories about emotions and relationships
 Patient’s emotional reaction and the relationship had a
creative influence on the story

 And I think, then she experiences a relation between two

human beings. That I think is important. This is the way
we work in the dialogue, to get some, what could I call it,
some feelings on the table which the patient has to tackle,
and I have to tackle, and then we must see how we
manage. The relation between, really, what happens just
between us.

14 Annette Sofie Davidsen, MD, PhD 12/08/2021

adavid@sund.ku.dk
Stories about irritation
 Tired of patients
 Stories created by irritation
 Not interested in hearing incoherent stories

 To be honest I had actually become somewhat tired of her,

so I simply could not stand it any more

15 Annette Sofie Davidsen, MD, PhD 12/08/2021

adavid@sund.ku.dk
Family physician: Some can be enormously irritating.
She made me – well, she was really irritating, unctuous,
and would tell of all these horrible things she had – and
how it hurt here and there.
Interviewer: but was that someone you could ask to tell
her life story to get another view of her?
Family physician: no, she was too irritating, too
peculiar. I’m damned if I think so. It must be some who –
who you are somewhat interested in hearing about. I was
not interested in hearing about her.

16 Annette Sofie Davidsen, MD, PhD 12/08/2021

adavid@sund.ku.dk
Stories about categorization and biomedical
perspectives
 Much shorter
 About
 Biomedical diagnoses
 Prescription
 Sick leave
 Medical certificates
 Reluctant to tell patient stories
 Did not know details

17 Annette Sofie Davidsen, MD, PhD 12/08/2021

adavid@sund.ku.dk
Interpretation of results

 Family physicians have different theoretical frames of

reference for understanding patients
 Different consultation styles
 Different discourses of understanding
 Different professional positioning
 Manifests itself through the style of narratives they tell
about their patients
 The style is global and consistent

18 Annette Sofie Davidsen, MD, PhD 12/08/2021

adavid@sund.ku.dk
Implications
 Training a narrative understanding could increase family
physicians’ psychological understanding of patients.

 The conditions in family practice are suitable for this

approach

19 Annette Sofie Davidsen, MD, PhD 12/08/2021

adavid@sund.ku.dk
20 Annette Sofie Davidsen, MD, PhD 12/08/2021
adavid@sund.ku.dk