In this chapter I will discuss how doctor participants were recruited to phase two of this research study and give a detailed account of doctor recruitment, interview procedure and data analysis.
7.1 Design
The aim of phase two was to answer the following questions:
How is whiplash injury perceived and treated by professionals?
Are there differences between how the injury is perceived by the patient and
how it is perceived and treated by practitioners?
What, if any, are the implications of the experience of whiplash injury for healthcare provision?
These had to be translated into questions that would be flexible and allow doctors‟
personal understanding of whiplash injury to be given. One in-depth semi-structured interview was carried out with doctors between September 2004 and February 2006.
7.1.1 Sampling Strategy
In keeping with phenomenological inquiry, purposive sampling is often used (Crotty, 1996). The main principle behind this type of sampling is the „researcher‟s judgement as to typicality or interest‟ (Robson, 1993:141). I wanted to gain a rich description of doctors‟ experiences of treating whiplash injury. From my experience of working in the NHS, I thought that Accident and Emergency, Primary Care and Occupational
Health were the areas of expertise that were most likely to provide me with the data that I hoped to obtain.
7.1.2 Recruitment
I asked a well respected doctor who worked in Primary Care for names of doctors who worked within the Huddersfield area of Kirklees and would have expertise in the areas outlined above that I could invite to take part in the study. They were sent an information pack that contained a letter informing them of the study, an acceptance form and a pre paid envelope to return their response (see appendix 14). Recently qualified doctors in postgraduate education at the University of Huddersfield were also informed by email about the study and invited to participate. When I received a reply from a potential participant I contacted them by telephone to confirm their intention to take part in the study, answer any initial queries they may have had and arrange a convenient time and location to carry out the interview.
7.1.3 Sample
A total of twelve potential doctor participants were invited to take part in the study.
Eight doctors agreed to take part (see table 5 page1945 for summary). Three doctors were from the hospital setting and five doctors were from Primary Care. The doctors‟
range of experiences and interests, other than basic medical training, included: child health, disabilities, general practice, occupational health, sports medicine, teaching and trauma. Four doctors declined to take part in the study. The reasons given by the experienced doctors for not taking part in the study were a heavy workload or a lack of interest in the subject matter. I was both surprised and disappointed to find that the doctors who had recently qualified declined to take part in the study. My surprise was
due to the more recent emphasis being placed on healthcare professionals to conduct research themselves. I naively thought that this would have made them more willing to participate. Unfortunately, no reasons were given by this group so I can only assume that they may have felt they had nothing to contribute to the study.
7.1.4 Participant Profiles
To maintain anonymity I have assigned a letter to follow the title of doctor instead of their name. The designation of a letter and not a personal name is a reflection of my professional background and the professional manner in which doctors are addressed.
Dr A is a male doctor whose background is in Primary Care. Dr A works as a GP and also works in postgraduate medical education as a supervisor and lecturer. Years of practice not known.
Dr B is a male doctor whose background is in Primary Care. Dr B works as a GP and has also worked in the Benefits Medical Agency. Dr B has worked as a doctor for 25 years.
Dr C is a male doctor whose background is in Accident and Emergency medicine. Dr C works in an Accident and Emergency department as a Consultant. Dr C has worked as a doctor for 14 years
Dr D is a male doctor whose background is in Accident and Emergency medicine. Dr D works in an Accident and Emergency Department. Dr D has worked as a doctor for
Dr E is a male doctor whose background is in Accident and Emergency medicine. Dr E works in an Accident and Emergency Department. Dr E has worked as a doctor for 15 years.
Dr F is a male doctor whose background is in Primary Care and Occupational Health medicine. Dr F works as a GP, an Occupational Health doctor and is involved in sports medicine. Dr F has worked as a doctor for 15 years.
Dr G is a female doctor whose background is in Primary Care. Dr G works as a GP.
Dr G has worked as a doctor for 23 years.
Dr H is a female doctor whose background is in Primary Care. Dr H works as a GP.
Dr H has worked as a doctor for 18 years.
Table 6 Breakdown of doctor interviews
Site of interview Duration of interview
Recorded
Dr A Work 15 mins Yes
Dr B Work 22 mins Yes
Dr C Work 20 mins Yes
Dr D & Dr E Work 35 mins Yes
Dr F Work 20 mins Yes
Dr G Work 10 mins Yes
Dr H Home 10 mins Yes
7. 2 Interviewing
The difficulties I faced with wanting to interview doctors as group were concerned with the practicalities of getting a group of doctors from a variety of locations together. The issue of time was a major consideration due to the time involved in travelling to the venue and the doctors varied work schedules. This aspect meant that it was more practical for me to conduct individual interviews. For this reason individual interviews were chosen to explore the doctors‟ experiences of treating patients with whiplash injury.
7.2.1 Developing the doctor interview schedule
The interview schedule was developed with the aim of elucidating the doctor‟s own understanding and treatment of whiplash injury. The schedule was structured around the following questions:
1. Can you tell me what whiplash injury means for you?
2. Can you tell me about your experience of treating whiplash injuries?
3. Can you tell me if you have had experience of treating whiplash injuries on a
4. Can you tell me about a patient who didn‟t recover as quickly as you would have expected them to and why you think that happened?
7.2.2 Piloting the doctor interview schedule
I piloted the interview schedule on one doctor who worked in Primary Care. The interview was recorded on a minidisk player. Whilst piloting the interview schedule I added a new question that asked the participant about their own thoughts as to why whiplash injuries were said to be on the increase (see appendix 14). This was because their responses might help generate new insights that might be helpful for healthcare providers when planning future service developments. The feedback from this interview showed the questions to be satisfactory. Piloting the interview also enabled me to give a more accurate estimation of the time needed to conduct the interview. I had originally thought the interview would take about an hour but I was able to revise that to thirty minutes. Due to the small number of doctor participants and the fact that no revisions were necessary, the pilot interview was included within the data set.
7.2.3 Interview setting
The factors that I discussed regarding the interview environment in chapter four with the patient interviews, also needed to be considered with the doctor interviews. The participants were given the opportunity to be interviewed at their place of work, the university or their own home. Whilst interviewing people at their place of work can be considered unsuitable as participant anonymity might be compromised for busy healthcare professionals, it might be the most convenient place for the interview to take place. Seven out of the eight participants chose to be interviewed at their place of work. Two of the participants were work colleagues and they requested to be
interviewed together for convenience. This appeared to be as much for me as it was for them. One participant chose to be interviewed at home. Interviewing the doctors at work gave a more formal feel to the interview. I also found that I had to be patient when conducting the interview as on one occasion the doctor was called away to see a patient and then came back to continue the interview, whereas another interview had to finish because of an emergency. This was problematic as it interrupted the flow of data being generated and resulted in a loss of potential data. Even though I understood why the doctor was called away I did find that situation to be extremely frustrating especially when I was unable to resume the interview.
7.2.4 Interview Process
I introduced myself to each participant as a researcher from the University of Huddersfield. The interview began with an explanation about the purpose of the research and its anticipated outcomes, and the participants consent to take part in the study and to record the interview was obtained. The participant was also informed that they could stop, or even withdraw from, the interview at any time and that they were under no obligation to answer all the questions and share that information with me.
Once the formality of the introductions was over, I began recording and used the interview schedule to conduct the interviews. During the interview, I used the interview schedule as a mechanism to stop me from taking a medically oriented response and less fruitful harvest of data. This was a very real possibility given my previous working relationships with doctors. Before the interview was completed, the participant was given the opportunity to ask questions or to add anything else they might want to say. I informed them that I would give them a copy of their interview
transcript once it had been transcribed and they would be able to read and comment on the material. None of the doctor participants commented on their transcripts.
7.2.5 After the interview
When I left the interview site, I telephoned a member of the supervision team to inform them that the interview had been completed and that everything was satisfactory. I recorded my general impressions of the interview in my notebook when I returned to my car or as I was sitting waiting for the bus to arrive as the interview was still fresh in my mind. Once I arrived back, I would listen to the recording to make sure it was satisfactory and then place the material in a locked filing cabinet for safety.
7.3 Analysis
As with the patient interviews (see chapter four for a full account), the interview data were transcribed verbatim by me and identifying data was removed from the transcripts. As the doctors; interviews were of shorter duration than the patients‟
interviews it meant that this process was less time consuming than it had been with the patients‟ interviews.
7.3.1 Analysis: Template analysis
Analysis and development of the template differed from the process as described earlier in chapter four, with the patients‟ data set. This was because I used two a-priori themes to structure this template. The two themes that I used were „whiplash: a minor injury‟, from the template used in patient analysis, and „the consultation‟. The