Vicarious trauma is an understudied phenomenon among Canadian family physicians.
This phenomenological study set out to explore the experiences of a group of inner-city family physicians caring for women using illicit drugs.
Ten family physicians working in Toronto and Ottawa, Canada, participated in in-depth interviews. The data were analyzed using an iterative and interpretive process.
The first major theme emerging from the data analysis was the emotional impact of the work. Participants shared the challenges, sorrows, and joys they experienced as they struggled to care for their patients. The sub-themes identified were as follows: tragedy and death, difficult behaviors, and isolation from mainstream medical community. The second major theme identified was coping strategies. Participants were open, thoughtful, and eloquent as they reflected on the three primary coping strategies reported: adaptation and evolution of practice style, teamwork, and modification of expectations.
Participants, narratives of loss, grief, and compassion were consistent with vicarious trauma and therefore participants risked developing compassion fatigue--a specific form of burnout. These are new and important findings. Further research exploring vicarious trauma as a possible contributor to burnout among family physicians is warranted.
Comment In: J Am Board Fam Med. 2012 Nov-Dec;25(6):756-823136311
To examine family physicians' experiences in caring for patients with serious mental illness and their expectations of a shared mental health care (SMHC) model.
Qualitative method of in-depth interviews.
Purposive sample of 11 full-time family physicians providing ongoing care for patients with serious mental illness.
Eleven interviews were conducted to explore family physicians' experiences. All interviews were audiotaped and transcribed verbatim. Analysis was done using a constant comparative approach and was carried out concurrently rather than sequentially. Researchers read all interview transcripts independently before comparing and combining their analyses. Final analysis involved examining all interviews together to discover relationships between and among emerging themes.
Findings reflected three main themes: what family physicians perceive they bring to care of seriously mentally ill patients (i.e., whole-person approach to care); challenges family physicians face in participating in shared care of these patients (i.e., communication and access issues); and family physicians' expectations of a SMHC model (i.e., guidance and feedback).
As seriously mentally ill patients are moved out of institutions, the need for an effective and efficient SMHC model becomes imperative. Our findings suggest that family physicians could be an important part of SMHC models but only if systemic barriers are removed and collaborative practice is encouraged.
To explore factors that influence senior medical students to pursue careers in family medicine.
Qualitative study using semistructured interviews.
University of Western Ontario (UWO) in London.
Eleven of 29 graduating UWO medical students matched to Canadian family medicine residency programs beginning in July 2001.
Eleven semistructured interviews were conducted with a maximum variation sample of medical students. Interviews were transcribed and reviewed independently, and a constant comparative approach was used by the team to analyze the data.
Family physician mentors were an important influence on participants' decisions to pursue careers in family medicine. Participants followed one of three pathways to selecting family medicine: from an early decision to pursue family medicine, from initial uncertainty about career choice, or from an early decision to specialize and a change of mind.
The perception of a wide scope of practice attracts candidates to family medicine. Having more family medicine role models early in medical school might encourage more medical students to select careers in family medicine.
Cites: Fam Pract. 1997 Jun;14(3):194-89201491
Cites: Acad Med. 1997 Jun;72(6):534-419200589
Cites: Fam Med. 1999 Sep;31(8):551-810489637
Cites: Fam Med. 1999 Sep;31(8):559-6510489638
Cites: Acad Med. 1999 Sep;74(9):1011-510498095
Cites: Acad Med. 1997 Jul;72(7):635-409236475
Cites: CMAJ. 1997 Mar 1;156(5):682-49068578
Cites: Fam Med. 1999 Oct;31(9):641-610554724
Cites: Fam Med. 2000 May;32(5):320-510820673
Cites: Br J Gen Pract. 2000 Jun;50(455):483-510962790
Cites: Fam Med. 2000 Sep;32(8):543-5011002864
Cites: CMAJ. 2002 May 28;166(11):1419-2012054410
Cites: Acad Med. 1993 Jul;68(7):572-48323652
Cites: Fam Med. 1994 Sep;26(8):500-37988807
Cites: J Gen Intern Med. 1997 Jan;12(1):76-79034952
Comment In: Can Fam Physician. 2003 Dec;49:159214708922
Comment In: Can Fam Physician. 2003 Sep;49:1065, 106914526852
This article examines compassion fatigue within double duty caregiving, defined here as the provision of care to elderly relatives by practicing nurses. Using qualitative data from our two studies of Canadian double duty caregivers, we identified and interviewed 20 female registered nurses whom we described as "living on the edge." The themes of context, characteristics, and consequences emerged from the findings. In this article, we argue that being both a nurse and a daughter leads to the blurring of boundaries between professional and personal care work, which ultimately predisposed these caregivers to compassion fatigue. We found that the context of double duty caregiving, specifically the lack of personal and professional resources along with increasing familial care expectations, shaped the development of compassion fatigue. Nurse-daughters caring for elderly parents under intense and prolonged conditions exhibited certain characteristics, such as being preoccupied and absorbed with their parents' health needs. The continual negotiation between professional and personal care work, and subsequent erosion of those boundaries, led to adverse health consequences experienced by the nurse-daughters. The study findings point to the need to move beyond the individualistic conceptualization and medical treatment of compassion fatigue to one that recognizes the inherent socio-economic and political contextual factors associated with compassion fatigue. Advocating for practice and policy changes at the societal level is needed to decrease compassion fatigue amongst double duty caregivers. In this article we review the compassion fatigue literature, report our most recent study methods and findings, and discuss our conclusions.
This article describes the experiences, feelings, and ideas of living kidney donors. Using a phenomenological, qualitative research approach, the authors interviewed 12 purposefully selected living kidney donors (eight men and four women), who were between four and 29 years since donation. Interviews were audiotaped, and transcribed verbatim, and the analysis of the data was both iterative and interpretive. Three key themes emerged. The first was how witnessing their loved ones' experience of illness and the threat of losing the recipient influenced the participants' decision to donate. The second focused on intrapersonal (philosophy of life) and interpersonal factors (comprehensive social support networks) that influenced the decision to be tested as a potential donor and the actual process of donation. The third was the impact of giving the gift of life, which was emotional and life changing. This article provides a rich description of the experiences of living kidney donors, revealing the multiple factors influencing the decision to donate, and provides insight on how social workers and other health care professionals need to identify and address the psychosocial needs of living kidney donors and their families from the process of decision making through after donation.
Obstetrical practice by family physicians has been declining rapidly for many reasons over the past number of decades. One reason for this trend is family medicine residents not considering intrapartum care as part of their future careers. Decisions such as this may be related to experiences during obstetrical training. This study explored the experiences of family medicine residents in core primary care obstetrics training.
Using qualitative approaches, focus groups of family medicine residents were conducted. The resulting data were audiotaped and transcribed verbatim. Independent and team analysis was both iterative and interpretive.
Data obtained from the focus groups revealed findings relating to the following categories: (1) perceived facilitators to practicing primary care obstetrics, (2) perceived barriers to practicing primary care obstetrics, and (3) learner experiences at the fulcrum of career decision making.
Family medicine residents were encouraged by favorable learning experiences and group shared-call arrangements by their primary care obstetrics preceptors. Some concerns about a career including obstetrics persisted; however, positive experiences, including influential fulcrum points, may inspire family medicine residents to pursue a career involving primary care obstetrics.
To explore the nature of professional stress and the strategies used by family physicians to deal with this stress.
Ten key-informant family physicians.
In-depth interviews were conducted with key informants. A total of 40 key informants were identified, based on selected criteria; 24 provided consent. The potential participants were rank-ordered for interviews to provide maximum variation in age, sex, and years in practice. Interviews were conducted, audiotaped, transcribed verbatim, and analyzed until thematic saturation was reached, as determined through an iterative process. This occurred after 10 in-depth interviews. Immersion and crystallization techniques were used.
The participants described professional stresses and strategies at the personal, occupational, and health care system levels. Personal stressors included personality traits and the need to balance family and career, which were countered by biological, psychological, social, and spiritual strategies. Occupational stressors included challenging patients, high workload, time limitations, competency issues, challenges of documentation and practice management, and changing roles within the workplace. Occupational stressors were countered by strategies such as setting limits, participating in continuing medical education, soliciting support from colleagues and staff, making use of teams, improving patient-physician relationships, exploring new forms of remuneration, and scheduling appropriately. Stressors affecting the wider health care system included limited resources, imposed rules and regulations, lack of support from specialists, feeling undervalued, and financial concerns.
Family physicians face a multitude of challenges at personal, occupational, and health care system levels. A systems approach provides a new framework in which proactive strategies can augment more than one level of a system and, in contrast, reactive strategies can have negative inputs for different system levels.
Cites: Can Fam Physician. 2001 Apr;47:737-4411340754
Cites: N Engl J Med. 2004 Jan 1;350(1):69-7514702431
Cites: BMJ. 1988 Aug 20-27;297(6647):528-303139188
Cites: Fam Med. 1992 Nov-Dec;24(8):591-51426727
Cites: CMAJ. 1995 Nov 1;153(9):1283-97497390
Cites: Can Fam Physician. 2008 Feb;54(2):234-518272641
Cites: Br J Gen Pract. 1996 Mar;46(404):157-608731621
Cites: Can Fam Physician. 1996 Jul;42:1319-268754701
To describe cancer patients' experience of the role of family physicians (FPs) in their care.
Mail survey of a random sample of patients from the Manitoba Cancer Registry.
Two hundred two adults, 6 to 12 months after diagnosis.
Proportion needing different kinds of help from FPs and their rating of FPs' response; FACT-G quality-of-life score.
Response rate was 56.6%; two thirds of the sample were in the follow-up phase. Most (91%) had an FP involved in their care, but FP involvement decreased after diagnosis. The most frequently needed kinds of help (with general medical problems, quick referrals, taking extra time, and quick office appointments) were well provided by FPs, but family support was not. Higher quality-of-life scores were associated with more help with general medical problems, more provision of cancer-related information, and more emotional support of patients and their families.
Family physicians respond well to the most common needs of cancer patients and should be proactive in offering their support to both patients and families.
Cites: Fam Pract. 1986 Sep;3(3):168-733770337
Cites: J R Coll Gen Pract. 1985 Jul;35(276):326-84032363
Cites: JAMA. 1983 Feb 11;249(6):751-76823028
Cites: Can Fam Physician. 2003 Jul;49:890-512901486
Cites: Can Fam Physician. 2003 Jul;49:882-612901484
Cites: Med Care. 2003 May;41(5):582-9212719681
Cites: Can Fam Physician. 2001 Oct;47:2009-12, 2015-611723595
Cites: BMJ. 2000 Apr 22;320(7242):1090-110775205
Cites: Soc Sci Med. 2000 Jan;50(2):271-8410619695
Cites: Cancer. 1990 Aug 1;66(3):610-62364373
Cites: Cancer Prev Control. 1999 Apr;3(2):137-4410474761
Cites: Prim Care. 1998 Jun;25(2):401-69628959
Cites: Can Fam Physician. 1996 Sep;42:1712-208828874
Cites: BMJ. 1996 Sep 14;313(7058):665-98811760
Cites: Can J Oncol. 1994 Jul;4(3):285-907529630
Cites: J Clin Oncol. 1993 Mar;11(3):570-98445433
Cites: Can Fam Physician. 1993 Jan;39:49-578382093
Cites: Prim Care. 1992 Dec;19(4):835-521465491
Cites: Cancer. 1991 Mar 15;67(6 Suppl):1759-662001574
To explore family physicians' experiences in dealing with genetic susceptibility to cancer.
Qualitative study using focus groups.
Four Ontario sites: northern, rural, urban, and inner city.
Forty rural and urban FPs participated in four focus groups: 28 were male; average age was 41.
Focus groups using a semistructured interview guide were audiotaped and transcribed. The constant comparative method of data analysis was used. Key words and concepts were identified. Data were sorted using NUD*IST software.
Participants realized the escalating expectations for genetic testing and its effect on family practice. They explored an expanded role for themselves in genetic testing. Possible activities included risk assessment, gatekeeping, and ordering genetic tests. They were concerned about the complexity of genetic testing, the lack of evidence regarding management, and the implications for families.
We must help FPs struggling to integrate genetics into their practices, by addressing their concerns, enhancing the way they communicate information on genetics, and developing appropriate educational tools.
Cites: Fam Pract. 1999 Aug;16(4):426-4510493716
Cites: Fam Pract. 1999 Oct;16(5):468-7410533942
Cites: J Community Health. 1999 Feb;24(1):45-5910036647