title: Power and powerlessness: GPs' narratives about lifestyle counselling.
abstract: BACKGROUND
  Power in doctor-patient relationships is asymmetrically distributed. The doctor holds resources the patient needs and has a mandate to promote healthy living. Power may benefit or harm the patients' health, and the doctor-patient relationship.
  
  
  OBJECTIVE
  To identify aspects of power and powerlessness in GPs' narratives about lifestyle counselling.
  
  
  METHODS
  A qualitative study using focus groups from peer-group meetings of Norwegian GPs attending continuing medical education.
  
  
  METHODS
  GPs discussed case stories about lifestyle counselling in focus groups. The discussions were transcribed and the text analysed using systematic text condensation.
  
  
  RESULTS
  Aspects of power concerning the framework of the consultation and the GPs' professional role were  found. Also identified were: power expressed by opportunistic approaches to change patients' lifestyle; rhetoric communication; paternalism; and disclosure. GPs reported powerlessness in complex communication, when there were difficulties reaching goals, and when patients resisted or ignored  their proposals.
  
  
  CONCLUSIONS
  Case-study discussions in peer groups disclose several aspects of power and powerlessness that occur in consultations. Consciousness about aspects of power may facilitate counselling that benefits the patient and the doctor-patient relationship.
authors.affiliation: Department of Public Health and Primary Health Care, University of Bergen, Bergen, Norway. eabil@broadpark.no
authors.forename: Eirik
authors.initials: E
authors.lastname: Abildsnes
authors.forename: Liv Tveit
authors.initials: LT
authors.lastname: Walseth
authors.forename: Signe A
authors.initials: SA
authors.lastname: Flottorp
authors.forename: Per S
authors.initials: PS
authors.lastname: Stensland
mesh_terms: D001291:Attitude of Health Personnel; D003142:Communication; D003376:Counseling; D030881:Disclosure; D004502:Education, Medical, Continuing; D005194:Family Practice / Q000193:education / Q000592:standards*; D017144:Focus Groups; D006801:Humans; D008019:Life Style; D033262:Narration; D009664:Norway; D026706:Paternalism; D010817:Physician-Patient Relations; D011209:Power, Psychological; D024382:Professional Role