What cancer tells us about general practice. Birth of an hypothesis

Abstract

We are presenting in this paper a study about general practitioners' behaviours and attitudes towards the cancer patients they take care of. To begin with, the approaching methods are presented in a critical way. The choice of these methods finds an explanation in the fact that we were looking for an information as near as possible to the real physicians' behaviours and supplying, at the same time, an important material, giving us the opportunity to undertake an interpretative analysis of the different medical cases about cancer patients (64) written by some (12) of the general practitioners (31) who had been interviewed before about cancer in their medical practice. We have tried, particularly, to point out and to illustrate with some examples the specific contribution of a chosen method compared with another one; for instance, the interviews compared to the written questionnaire, and the medical cancer cases written by the physicians compared to the interviews realized with the same general practitioners. In this paper we are also trying to report the preoccupations, the difficulties and the theoretical and methodological problems which appeared during the process of this research. Concerning the findings of this study, it is possible to assert that the main hypothesis seems coherent with the collected information: it really seems that cancer, with its social image in which fear for suffering and for dying prevail, is for the general practitioner a borderline situation in which his personal psychology and his feelings seem to play a more important part than his medical knowledge. In this 'drama', his previous relationship to his patient, the type of cancer involved, the patient's social and family background, the way in which he represents his profession, his medical experience, as well as his specialists network, also play an important part. If cancer is a challenge for the general practitioner, it seems that it is especially a challenge for the image he has of himself as a physician, but also as a human being, precisely because the part he can play concerning the therapeutics is very small. So, unlike the thesis of some authors, we think that the general practitioners (as a result also of a widely spread adhesion to values of a non-technical idea of his practice) can assume a determinant function, by advising the patient, by doing in the same time a good following up of the disease he suffers from, and by keeping with him a good relationship, which he often qualifies as 'interesting'.