Challenging clinical encounters: an investigation into the experiences of GPs consulting with young people experiencing emotional distress and an exploration of the GP’s role

Background Young people who consult with their GP are known to have a higher psychological morbidity and accompanying emotional distress, than those who do not seek help. A small body of research has identified that GPs have difficulty in identifying emotional distress in this patient population unless it is severe. The implications of a low detention rate of distress by GPs include recurrent and enduring distress which continues into adult life and impacts negatively on social, educational, psychological and emotional development. Consultations with young people in this clinical arena can be problematic yet little is known about how the situation is perceived by GPs. In contrast, GPs are increasingly involved in responding to adults with emotional distress and psychological difficulties and their involvement has been well researched. The research presented here explores GPs’ views and experiences of managing emotional distress in young people who present in general practice. Methodology Grounded theory methodology was used, augmented by the application of situational analysis. Nineteen semi-structured interviews were conducted with practising GPs in the North East of England between January 2009 and July 2010. Findings and conceptual theory GPs vary in their degree of engagement with young people who present with emotional distress. This clinical terrain is perceived by the majority as being unfamiliar territory and creates professional anxiety and uncertainty. Three domains emerged as being pivotal in shaping a GP’s response to this problematic situation. They are defined as a GP’s performance in the clinical encounter; a GP’s perspective of young people and their health needs and a GP’s epistemological frame of reference. These domains form the pillars of the conceptual theory. The three areas intersect with each other to shape a iv GP’s engagement with emotionally distressed young people; which is translated in the clinical encounter as ‘the enactment of role’. Conclusion A GP’s role in responding to emotional distress in young people is ill-defined and unsupported. This results in anxiety and uncertainty about how to proceed. By developing a conceptual theory to explain what influences GPs’ responses in this challenging clinical encounter it is possible to support greater involvement of GPs with young people who present with emotional distress. This has implications for education, practice, research and policy