Age Gender Location YIP 10 Gen/Spec

Dr Islington 31 male metro 6 GP

Dr Norwood 32 female metro 9 GP

Dr Carmichael 34 female metro 11 GP

Dr Tobias 34 female metro 9 GP

Dr Humphries 35 male remote 8 GP

Dr Lester 36 male metro 10 GP

Dr Blake 36 male remote 12 GP

Dr Stephens 39 female rural 14 GP

Dr Jacobs 39 male metro 16 Specialist

Dr Farmer 39 female remote 14 GP

Dr White 42 female rural 19 GP

Dr Quentin 45 male metro 23 GP

Dr Graham 45 male metro 21 Specialist

Dr Rose 46 female metro 23 GP

Dr Connors 46 male rural 19 GP

Dr Davis 47 female metro 24 GP

Dr Ewing 47 male metro/rural 23 GP

Dr Vernon 49 female metro 25 GP

Dr Neville 49 male metro 24 GP

Dr Lewis 49 female rural 17 GP

Dr Allen 55 male metro 23 Specialist

Dr Dennis 57 male metro 33 Specialist

Dr Lascelles 58 male rural 34 GP

Dr Martin 61 male metro 38 GP

Dr Peterson 63 male metro 38 Specialist

Table 2 - Interviewee Characteristics

Table 2 – Interviewee Characteristics

9

The names shown here and throughout the thesis are all pseudonyms.

10

At the commencement of the interview phase, ‘official endorsement’ of the project was sought from medical organizations in an effort to gain credibility in the eyes of potential participants. Unfortunately, this proved to be an impossibility. Plan B entailed ‘cold-calling’ specific doctors who met certain criteria, but this, too, proved to be more difficult than had been originally supposed. For example, the main vehicle for contacting doctors was the telephone book, which provided the names and numbers of doctors and the place where they practised, but did not provide information about their age, where and when they had qualified and other issues relevant to the research. The search for Plan C reiterated Hertz and Imber’s (1995: viii) statement that few social researchers study elites ‘because elites are by their very nature difficult to penetrate’. During informal conversations about the project, several doctors emphasised that the best (or even the only) way to recruit participants would be to ‘tap into’ the informal networks linking doctors, thereby utilizing a modified snowball sampling technique.

The initial handful of snow to start the ball rolling comprised three doctors who had expressed an interest in the research and a willingness to be interviewed. They were all interviewed and asked whether they knew of any other doctors who might be interested in the research, and who had, for example, trained overseas or worked in a rural community for an extended period of time. Thus each interview yielded a list of potential interviewees. This process was repeated with each interviewee, with care being taken to request the contact details of doctors who met specified criteria. A letter of introduction was drafted with the assistance of an academic GP and sent to all potential participants (see Appendix A). Only two doctors declined the request to be interviewed.

Each doctor was telephoned within a few days of receiving the letter, to see whether they were willing to be interviewed and to make arrangements for the time and place of the interview. Most interviews were conducted at the doctor’s surgery. Several interviews were conducted at the interviewee’s home. All remote-area interviews were conducted over the telephone as finances prohibited travelling to interview in person. The written consent of all interviewees was obtained, with the relevant paperwork being posted or faxed to those doctors who were interviewed over the telephone (see Appendix B).

All interviews were recorded with a micro-cassette recorder, with the consent of the interviewees. A purpose-designed microphone was used to record the telephone interviews. No written notes were taken during the interviews to allow full concentration on the interviewee and the process of interviewing. The tapes of all interviews were transcribed in full as soon as possible after each interview had been conducted. The interviews lasted anywhere from 20 minutes (yielding around 2500 words) to just under two hours (yielding over 9000 words) with the average interview lasting around 40 minutes. The researcher completed a single page of ‘demographic questions’ for each interviewee (see Appendix C).

An interview guide11 provided a basic structure for the progress of the interview and covered all the main points relating to the central question of changes to the doctor-patient relationship.

Topics for discussion included, inter alia:

• Career/background

• Likes and dislikes about being a doctor

• Experience of different practice settings (if applicable)

11

This was expressly intended to be a ‘guide’ rather than a ‘schedule’ (See also Minichiello et al. 1995: 81-84).

• ‘Ingredients’ of a successful doctor-patient relationship

• Whether or not the doctor-patient relationship has changed/is changing

• Prompt for the following if not mentioned o patient expectations

o technology o information o Internet

o medico-legal climate

• Ideas about and experience of treating: o colleagues

o friends

o family members

• Ideas about and experience of being a patient

In total, the interviews yielded over 100,000 words of transcript. Verbatim transcription was completed in preference to ‘selective’ transcription. As shown by the example (see Appendix D) pauses, smiles, interruptions, laughter and other seemingly peripheral occurrences were included in transcriptions in an effort to capture as many elements of each interview as possible. This was enormously helpful during analysis since they conveyed much information in addition to the spoken word. Transcribing soon after each interview was beneficial because it enabled critical assessment of interview technique and adjustment and improvement of technique during subsequent interviews. The transcription was completed by the researcher rather than by a ‘third party’. The process of conducting the interviews, transcribing the interviews and making the necessary corrections to the transcripts, printing out and reading the transcripts, importing the transcripts into ATLAS, re-reading them and applying codes, and re-reading and applying more codes resulted in high levels of familiarity with the data.

Flexibility was retained throughout the time of interviewing. For example, when it became apparent that particular questions were not effective, alternative questions were asked to subsequent interviewees. For example, one journal entry (September 11, 1998) reads:

I’m interested to talk to doctors about patients with whom they have ‘a good relationship’. When I asked this question to my first interviewee early last week, he hesitated and became noticeably uncomfortable. I was puzzled by this, as I thought the intended meaning of the question was quite clear. At the second interview with another doctor, I asked the same question, and mentioned that the previous interviewee seemed uncomfortable with the question. The second doctor pointed out that the wording of that particular question emphasised a ‘relationship’, which could be misinterpreted as implying a personal or sexual relationship with ones’ patients. I feel so embarrassed at my naiveté!!! I will definitely reword that question….

Some issues that had not previously been considered emerged as the interviews progressed. Maintaining a flexible approach enabled incorporation of such insights. For example, very early in the field-work period one interviewee discussed his relationship with a retired GP with whom he was formerly in group practice:

Dr Quentin: (O)ne of my ex-partners..is a patient of mine. I actually find him very difficult because he has a very set agenda and is really looking for me to back up his opinion of things…(trails off)

Interviewer: Yep, yep, So, this other person, the ex-colleague of yours - the difficulty comes out of the fact that…?

Dr Quentin: (interrupting) He’s, he’s still … (raises voice, seems agitated) He wants to doctor himself. He’s doctoring himself and

I’m not really his general practitioner, I’m the second opinion.

Due to the pivotal nature of the issue of ‘treating fellow doctors’ and its links with the concept of expertise, the interview guide was subsequently amended to include a series of questions concerning having doctors as patients, and doctors' own experiences of being a patient. Similarly, doctors spoke about treating friends and family members quite differently from the way they spoke about ‘patients in general’. They often spoke about ‘trust’ when they were talking about this ‘special group’ of patients. After several doctors spoke about treating friends and family members, the decision was made to incorporate questions specifically about this group. Some key themes arising from these issues are discussed in Chapter 6.