Whose autonomy? Which choice? A study of GPs' attitudes towards patient autonomy in the management of low back pain.
BACKGROUND
Respect for patient autonomy is an important ethical principle for medical practitioners; however, previous investigators have reported inconsistent attitudes amongst practitioners towards respect for patient autonomy. This study in empirical ethics used qualitative methods to investigate GPs' attitudes towards respect for patient autonomy in consultations for low back pain.


OBJECTIVE
The aim of this study was to explore GPs' attitudes towards respect for patient autonomy by analysing attitudes towards four issues in the management of low back pain which raise ethical and practical dilemmas.


METHODS
Participants were 21 GPs selected from general practice in South Australia by stratified, purposive sampling aimed at maximizing diversity. Semi-structured interviews were tape-recorded, transcribed and analysed using codes developed from the transcripts, with additional theoretical codes. In the analysis, attitudes towards patient autonomy in the four issues were characterized as autonomy-respecting, intermediate or controlling.


RESULTS
The results showed individual inconsistencies in GPs' attitudes towards respect for patient autonomy. For example, the majority of GPs accepted patient autonomy in the use of complementary therapies, but were controlling with regard to the use of analgesics. Attitudes to duration of time off work were spread evenly, whilst controlling attitudes towards use of X-rays were modified by patient requests for X-rays.


CONCLUSIONS
These results suggest that GP attitudes towards patient autonomy are modified by ethical and pragmatic factors, and vary depending upon the nature of the issue in question.
Rogers
Wendy A
WA
Department of General Practice, Flinders University of South Australia, GPO Box 2100, SA 5001, Australia.
D000328:Adult; D000368:Aged; D001291:Attitude of Health Personnel; D003657:Decision Making; D004992:Ethics, Medical; D005260:Female; D006801:Humans; D007407:Interviews as Topic; D017116:Low Back Pain / Q000534:rehabilitation*; D008297:Male; D008875:Middle Aged; D010358:Patient Participation; D026684:Personal Autonomy; D010817:Physician-Patient Relations; D010821:Physicians, Family / Q000523:psychology*; D012494:Sampling Studies