Family Practice Advance Access originally published online on January 12, 2009
Family Practice 2009 26(2):115-120; doi:10.1093/fampra/cmn106
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‘I've broken my neck or something!’ The general practice experience of whiplash
a CT Lamont Primary Health Care Research Centre, Elisabeth Bruyere Research Institute, University of Ottawa—Department of Family Medicine, 43 Bruyere Street, Ottawa, Ontario K1N 5C8, Canada
b Department of General Practice, University of Western Australia, Western Australia
c Division of Health Sciences, Curtin University of Technology, Perth, Western Australia, Australia
Correspondence to Grant Russell, CT Lamont Primary Health Care Research Centre, Elisabeth Bruyere Research Institute, University of Ottawa—Department of Family Medicine, 43 Bruyere Street, Ottawa, Ontario K1N 5C8, Canada; Email: grussell{at}bruyere.org
Received 3 September 2008; Revised 3 December 2008; Accepted 8 December 2008.
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Abstract |
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Objective. To explore the experiences of patients and GPs concerning the management of mild to moderate whiplash.
Methods. Qualitative study using phenomenology. In-depth interviews with patients and their treating GPs. General practices in the northern suburbs of Perth, Western Australia. Participants. Maximum variation sample of nine patients suffering from mild to moderate whiplash and their treating GPs. GPs identified patients with recent whiplash. In-depth interviews were conducted with both groups. Patients were telephoned 3 months later to evaluate progress. Analysis used a constant comparative process and independent transcript review assisted by N-Vivo software.
Results. Patients articulated a need to be understood by a physician whom they knew and trusted. For all, the principal underlying concerns were about pain and the financial and physical impact of the injury, particularly in view of its perceived potential to harm the spine. While most patients expected medical interventions to help facilitate speedy recovery, physicians were far more pessimistic. Despite acknowledging the importance of addressing psychological needs, most GPs underestimated the degree of patient distress in the post-injury period. Although guardedly supportive of the local insurance system, GPs were scornful of patients seeking inappropriate compensation.
Conclusions. Findings highlight the influence of the patient–doctor relationship on clinical care in patients with whiplash, suggesting that the path to patient recovery and physician satisfaction may benefit if clinicians better understand patient experiences. The disconnect between patient and practitioner conceptualization of the problem challenges quality patient-centred care.
Keywords. Family medicine, occupational health, pain, patient-centred care, qualitative research.
Russell G and Nicol P. ‘I've broken my neck or something!’ The general practice experience of whiplash. Family Practice 2009; 26: 115–120.