title: Clinical Expert or Service Provider? Physicians' Identity Work in the Context of Counterprofessional Patient Requests.
abstract: Researchers often discuss patient-related outcomes of the shift from the paternalistic physician-to-patient model to those of patient participation, yet little is known about the impact of patient participation on physicians' professional identity. In this study, we explored the context of counterprofessional patient requests in which patient participation conflicts with medical professionalism. We interviewed 34 physicians, of whom 14 were family physicians and pediatricians, and 20 were specialists in various fields. Data were analyzed by a grounded theory approach. Our findings indicate that physicians experienced conflicts between their identities as clinical experts, caretakers, service providers, and resource allocators. To cope with the resulting tension, physicians used the strategies of hierarchy setting, integrating, incorporating the patient, and changing the meaning of an identity or the event. All strategies were implemented by cognitive and relational tactics.
authors.affiliation: University of Haifa, Haifa, Israel dyagil@research.haifa.ac.il.
authors.forename: Dana
authors.initials: D
authors.lastname: Yagil
authors.affiliation: Academic College of Tel Aviv-Jaffa, Tel Aviv, Israel.
authors.forename: Hana
authors.initials: H
authors.lastname: Medler-Liraz
mesh_terms: D000328:Adult; D000368:Aged; D001291:Attitude of Health Personnel; D002983:Clinical Competence; D003657:Decision Making; D005260:Female; D019538:Health Care Surveys; D006801:Humans; D007407:Interviews as Topic; D007557:Israel; D008297:Male; D008875:Middle Aged; D010358:Patient Participation / Q000523:psychology; D010819:Physician's Role / Q000523:psychology*; D010817:Physician-Patient Relations; D010820:Physicians / Q000523:psychology*
keywords: communication, medical; decision-making; health care professionals; participation, social; relationship, patient–provider