Multiple morbidity and moral identity in mid-life: accounts of chronic illness and the place of the GP consultation in overall management strategies

Abstract

This study was conceived against the backdrop of academic and medically based discussions about inappropriate use of General Practice, in the context of an overburdened and under resourced National Health Service. Both frequent and less frequent consulters prioritised dilemmas around functional ability, reporting attempts to control illness, and resist loss of normal life and familiar selves. Despite our attempts to sample frequent and less frequent users with similar levels of morbidity in the more detailed qualitative interviews the frequent consulters conveyed more severe illness, which limited their lives and challenged their coherent and moral identities. Cultural, structural and social factors combined to influence health actions; personal troubles were linked to public matters. The accounts revealed how the severity of condition combined with social position influenced the place of the GP consultation in overall management strategies. Women and men communicated common problems, but also discussed experiences which were related to their traditional family roles. Housing status was not revealed as significant, in the context of a complex combination of micro and macro influences on experience. In the frequent consulters’ accounts the role of the GP was magnified in lives diminished and disrupted by chronic illness, whereas the less frequent consulters’ accounts presented a more peripheral role for their GP. Using Bourdieu’s central concepts, the GP was conceptualised as a ‘dispenser of capital’. Throughout, all of the participants described the hard work of illness management, and they used the accounts to display their moral competence. The medical encounter was conveyed against a moral backdrop, and this may have had implications for frequency of consulting. Overall, the symbolic and physical burden of chronic illness was highlighted