The goal of this 30-month qualitative anthropological study is to describe and examine the ways in which 100 primary care physicians explain and approach everyday clinical-ethical decisions, dilemmas and obstacles in their practice with geriatric patients. The study has three specific aims: in order to reach decisions; 30 to investigate various structural or institutional constraints that impinge on physicians' delivery of health care. Data will be collected through in-depth, open-ended interviews with practicing physicians in internal medicine, family practice, general practice, and geriatrics. All physicians who participate will have a significant portion of their practices devoted to the care of older persons and will face clinical-ethical dilemmas with some regularity. Interviews will be supplemented by participant observation at appropriate case conferences and institutional ethics committee meetings. Qualitative content analysis will be the data analysis method used. Three distinct approaches of this technique will be employed: 1) cross- sectional comparison, in order to describe discrete patterns of thought, opinion, and behavior, and the variations therein; 2)thematic analysis and the case study approach, to identify themes that emerge within a specific case; and 30 frequencies of response, in which frequencies of themes and other variables are generated. Ethnograph, a social science computer software tool, will be used to facilitate the management, sorting, and coding of quantitative data. The interpretive goal of the project is to make explicit some of the tacit values, developments, and definitions in the day to day clinical-ethical work of physicians that have contributed to dilemmas in geriatric care. To date there have been no systematic, empirical studies which investigate the everyday problems physicians face in providing care to older patients. This project will contribute to our understanding of a) how physicians approach and respond to clinical-ethical dilemmas, and b) how moral decisions in geriatric medicine actually get made.
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|Kaufman, S R (1995) Decision making, responsibility, and advocacy in geriatric medicine: physician dilemmas with elderly in the community. Gerontologist 35:481-8|