Huisartsgeneeskunde: aantrekkingskracht en beroepstrouw ... - Lirias

KCE Reports 90 Making General Practice Attractive: Encouraging GP attraction and Retention 65
interviewer to probe areas suggested by the respondents’ answers, picking up
information and in this way exploring specific topics. This could be done by prepared
questions or just by asking for more detail and depth.
The selected GPs were contacted to arrange the interview. Interviews were performed
at the participants’ premises and took between 45 – 90 minutes.
4.3.4 Analysis
All interviews were audiotaped and transcribed verbatim. The grounded theory
approach (Constant Comparison method) was used to analyze the data. Open coding is
the first step in the analytic process. In the process of coding, pieces of text were
identified and labeled. In a second step these open codes were grouped into concepts
(axial coding).
Two researchers (LS, HB) independently coded one Dutch interview following this
procedure and a list of codes was developed. During the axial coding process, it
appeared that codes concerning experiences during training and work as a general
practitioner could be arranged following the concepts and sub-concepts in a topic
matrix. Concepts and sub-concepts were added if new information was available.
Separate concepts were developed for the motivation to study medicine and to choose
for general medicine. Codes regarding experiences with the new profession and
suggestions for the future were also aggregated in a concept list (appendix 4.4.). The
French-speaking researcher (CD) also coded one interview in French and independently
developed a list of codes and concepts. During a first meeting two researchers (CD,
HB) compared all concepts and aligned their lists of concepts and coding.
This list of concepts was used and adapted if necessary during the analysis of the 14
remaining interviews. A constant comparison of concepts lead to the final lists of
concepts related to the decision of young GP to stop their practice-work. During a
second meeting 2 researchers (CD, HB) discussed these concepts and came to an
agreement on the most prominent findings.
In a final step of the coding process, the concepts were further aggregated and
structured by the 3 researchers (CD, HB, LS). A central concept ‘being overwhelmed –
overpowered by the job’ was agreed upon and all other concepts were structured
around this theme (see the concept frame in appendix 4.5.).
4.4 RESULTS
A remarkable observation during the interviews was that many interviewees showed
their emotions of anger, greave and sometimes relief. Some of them even cried.
For many interviewees, the decision process was a very complex one, which greatly
upset them. Some GPs are still dealing with emotional feelings and are ambiguous about
their decision. Most of them have not closed the door for taking up a job in general
practice in the future.
MG5 « quitter mes patients, ça n’a pas été simple… faire un brin de causette dans la
salle d’attente avec eux »
HA1 « Ja, ik heb mij echt twee jaar moeten voortsslepen,… ik heb zo twee jaar aan een
stuk eigenlijk heel veel opgekropt. En dingen die ik wilde vragen maar niet durfde
vragen. Euh en uiteindelijk dan twee jaar later heb ik gezegd van: dit kan zo niet meer
verder. »
HA 8 « Want mijn werk, dat, ik had het idee, ik doe dat goed. Ik doe dat met
toewijding. Maar ik kon niet goed tegen die druk van thuis. Want ik had zoiets van, ja, ik
heb geen andere oplossing. … Maar mijn kinderen, die begonnen dan echt, ja meer
uiterlijk tekenen van gemis… dan is dat echt aan mezelf gaan knagen…»…«.Ik zat echt
in een tweestrijd»…