The therapeutic encounter in general practice (Version 1)
Research type
Research Study
Full title
An ethnographic study of the therapeutic encounter in general practice
IRAS ID
230742
Contact name
Douglas I Hardman
Contact email
Sponsor organisation
University of Southampton
Duration of Study in the UK
1 years, 8 months, 29 days
Research summary
The therapeutic encounter – interactions between healthcare professionals and patients – is a central part of treatment. However, despite the introduction of the biopsychosocial model in primary care, how we currently evaluate treatment – the Randomised Controlled Trial (RCT) – sets disease apart from patients, focussing on specific treatments for specific diseases. This has implications for clinical care.
By using a ‘placebo’ to control for the psychological, social and cultural effects of treatment, an RCT has been an effective tool in advancing modern medicine. However, these effects are controlled for because they occur naturally. Healthcare professionals, as well as identifying and treating acute disease, must be able to harness that which an RCT intentionally obscures. And even with good intentions, time and bureaucratic constraints are making this increasingly difficult in modern primary care settings.
One way to investigate how to harness these treatment factors is through recent notions of clinical placebos. Through a modern understanding of placebos, it is not that they are or are not given to a patient – as in an RCT – rather that there are ‘placebogenic’ process and practices, involving psychological, social and cultural mechanisms, which can be exploited through the therapeutic encounter. These processes and practices might then be developed into formalised sequences of actions – clinical procedures – that can be used to improve patients’ symptoms by maximising treatment.
In this study we will conduct ethnographic fieldwork, over a period of one year in two general practices, to investigate the therapeutic encounter. We will use multiple methods including observation, interviews and focus groups, to understand potentially placebogenic processes and practices inherent in the therapeutic encounter, which could lead to symptomatic improvements in patients.
REC name
Yorkshire & The Humber - Bradford Leeds Research Ethics Committee
REC reference
17/YH/0427
Date of REC Opinion
7 Dec 2017
REC opinion
Favourable Opinion