Tensions between policy makers and general practitioners in implementing new genetics: grounded theory interview study
BMJ 1999; 319 doi: https://doi.org/10.1136/bmj.319.7222.1410 (Published 27 November 1999) Cite this as: BMJ 1999;319:1410
- a Department of Primary Medical Care, University of Southampton, Southampton SO16 5ST
- b Department of General Practice and Primary Care, St Bartholomew's and Royal London School of Medicine and Dentistry, Queen Mary and Westfield College, London E1 4NS
- Correspondence to: S Kumar
- Accepted 2 September 1999
Abstract
Objective: To explore general practitioners' perceptions of their role in implementing genetic technology.
Design: Grounded theory interview study.
Setting: Primary care.
Subjects: Purposive sample of 30 general practitioners with a further theoretical sample of 14.
Results: Inconsistencies were identified between policy makers' and general practitioners' definitions of general practitioners' role in implementing the new genetics. General practitioners emphasised the need to build on current practice, whereas policy makers focused on transforming practice to include the new specialised roles and skills. Two core themes were identified: genetics in a generalist context, which included appropriate generalist intervention, the ethical dilemmas implicit in the “therapeutic gap,” the familial-hereditary distinction in primary care, and the implications for generalist identity, including the potential marginalisation of generalism.
Conclusions: New technologies such as genetics that require implementation in general practice should be integrated within existing generalist frameworks.
Key messages
Tensions exist between the role of general practitioners in implementing genetic advances identified by policy makers and that identified by general practitioners themselves
General practitioners' ability to integrate patient experiences with genetic and other biomedical knowledge is a key generalist skill
New genetic technology should be integrated into existing generalist frameworks
General practitioners identified ethical dilemmas associated with the therapeutic gap
Footnotes
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Funding SK was funded by a Southern and Western NHS Research and Development research studentship grant.
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Competing interests None declared.
- Accepted 2 September 1999