Communication & Medicine, Vol 14, No 2 (2017)

‘We are the barriers’: Danish general practitioners’ interpretations of why the existential and spiritual dimensions are neglected in patient care

Elisabeth Assing Hvidt, Jens Søndergaard, Dorte Gilså Hansen, Pål Gulbrandsen, Jette Ammentorp, Connie Timmermann, Niels Christian Hvidt
Issued Date: 27 Mar 2018


Although it is broadly recognized that health problems often involve existential and spiritual dimensions, recent research shows that these aspects of illness are rarely attended to by health professionals. Studies explain this in terms of barriers to communication, but health professionals’ firsthand experiences and interpretations have so far been largely unexplored. Drawing on the theoretical traditions of phenomenology and hermeneutics, the present study presents Danish general practitioners’ (GPs’) experiences and interpretations of why the existential and spiritual dimensions are marginalized in patient care. We conducted seven focus groups, constituting a total sample of 31 GPs. Based on the analytic strategy of Interpretative Phenomenological Analysis (IPA), our analysis revealed that the GPs experienced and interpreted individual barriers as created and fostered within dominant biomedical and secular cultures that are characterized as ‘solution focused’ and ‘faith frightened’. Many GPs further understand themselves as barriers, because they are enculturated into these dominating cultures. We discuss these findings through theoretical concepts such as ‘secondary socialization’, ‘system colonization’ and ‘secularization’, and suggest interventions that might challenge current practice culture.

Download Media

PDF (Price: £17.50 )

DOI: 10.1558/cam.32147


Agledahl, K., Gulbrandsen, P., Førde, R. and Wifstad, Å. (2011) Courteous but not curious: How doctors’ politeness masks their existential neglect. A qualitative study of video-recorded patient consultations. Journal of Medical Ethics 37 (11): 650–654.

Alonso, Y. (2004) The biopsychosocial model in medical research: The evolution of the health concept over the last two decades. Patient Education and Counseling 53 (2): 239–244.

Andersen, P. B. and Lüchau, P. (2011) Individualiser­ing og aftraditionalisering af danskernes religiøse værdier [The individualization and detraditional­ization of the values of the Danes]. In P. Gundelach (ed.) Små og Store Forandringer. Danskernes Værdier siden 1981 [Small and Big Changes: The Values of the Danes since 1981]. Copenhagen: Hans Reitzels Forlag.

Andersen, R. S. and Vedsted, P. (2015) Juggling efficiency: An ethnographic study exploring healthcare seeking practices and institutional logics in Danish primary care settings. Social Science & Medicine 128: 239–245.

Assing Hvidt, E., Iversen, H. R. and Hansen, H. P. (2012) Belief and meaning orientations among Danish cancer patients in rehabilitation: A Taylorian perspective. Spiritual Care 1 (3): 1–22.

Assing Hvidt, E., Iversen, H. R. and Hansen, H. P. (2013) ‘Someone to hold a hand over me’: The significance of transpersonal ‘attachment’ relationships of Danish Cancer survivors. European Journal of Cancer Care 22 (6): 726–737.

Assing Hvidt, E., Søndergaard, J., Ammentorp, J., Bjerrum, L., Hansen, D. G., Olesen, F., Pedersen, S. S., Timm, H. U., Timmermann, C. and Hvidt, N. C. (2016) The existential dimension in general practice: Identifying understandings and experiences of general practitioners in Denmark. Scandinavian Journal of Primary Health Care 34 (4): 385–393.

Berger, P. L. and Luckmann, T. (1966) The Social Construction of Reality: A Treatise in the Sociology of Knowledge. Garden City, NY: Anchor Books.

Borrell-Carrió, F., Suchman, A. L. and Epstein R. M. (2004) The biopsychosocial model 25 years later: Principles, practice, and scientific inquiry. Annals of Family Medicine 2 (6): 576–582.

Butalid, L., Bensing, J. M. and Verhaak, P. F. (2014) Talking about psychosocial problems: An observational study on changes in doctor-patient communication in general practice between 1977 and 2008. Patient Education and Counseling 94 (3): 314–321.

Chibnall, J. T., Bennett, M. L., Videen, S. D., Duckro, P. N. and Miller, D. K. (2004) Identifying barriers to psychosocial spiritual care at the end of life: A physician group study. American Journal of Hospice and Palliative Medicine 21 (6): 419–426.

Coulehan, J. and Williams, P. C. (2003) Conflicting professional values in medical education. Cam­bridge Quarterly of Healthcare Ethics 12 (1): 7–20.

Derksen, F., Bensing, J., Kuiper, S., van Meerendonk, M. and Lagro-Janssen, A. (2015) Empathy: What does it mean for GPs? A qualitative study. Journal of Family Practice 32 (1): 94–100.

Dyer, A. R. (2011) The need for a new ‘new medical model’: A bio-psychosocial-spiritual model. Southern Medical Journal 104 (4): 297–298.

Engel, G. L. (1977) The need for a new medical model: A challenge for biomedicine. Science 196 (4286): 129–136.

Gadamer, H.-G. (1990) Wahrheit und Methode: Grundzüge einer philosophischen Hermeneutik, Tübingen: Mohr Siebeck.

Gallup, W. (2010) Religiosity Highest in World’s Poorest Nations. Retrieved from:

Grønvold, M., Pedersen, C., Jensen, C., Faber, M. and Johnsen, A. (2006) Kræftpatientens Verden. En Undersøgelse af hvad Danske Kræftpatienter har Brug for [The World of the Cancer Patient: An Investigation of what Danish Cancer Patients are in Need Of]. Copenhagen: Kræftens Bekæmpelse.

Gundelach, P. (2011) Små og Store Forandringer. Danskernes Værdier siden 1981 [Small and Big Changes: The Values of the Danes since 1981]. Copenhagen: Hans Reitzels Forlag.

Habermas, J. (1987) The Theory of Communicative Action. Boston: Beacon Press.

Heidegger, M. (1993) Sein und Zeit. Tübingen: Max Niemeyer Verlag.

Johannessen-Henry, C. T., Delatour, I., Bidstrup, P. E., Dalton, S. O. and Johansen, C. (2013) Associations between faith, distress and mental adjustment – A Danish survivorship study. Acta Oncologica 52 (2): 364–371.

Kirkeministeriet. (2016) Folkekirkens medlemstal. Retrieved from:

Koenig, H., King, D. and Carson, V. B. (2012) Hand­book of Religion and Health. New York: Oxford University Press.

La Cour, P. (2008) Existential and religious issues when admitted to hospital in a secular society: Patterns of change. Mental Health, Religion & Culture 11 (8): 769–782.

La Cour, P. and Hvidt, N. C. (2010) Research on meaning-making and health in secular society: Secular, spiritual and religious existential orienta­tions. Social Science & Medicine 71 (7): 1292–1299.

Liamputtong, P. (2011) Focus Group Methodology: Principle and Practice. London: Sage.

Mishler, E. (1984) The Discourse of Medicine: The Dialectics of Medical Interviews. Norwood, NJ: Ablex.

Nettleton, S., Burrows, R. and Watt, I. (2008) Regulating medical bodies? The consequences of the ‘modernisation’ of the NHS and the disembodiment of clinical knowledge. Sociology of Health and Illness 30 (3): 333-348.

Pedersen, H. F., Pedersen, C. G., Pargament, K. I. and Zachariae, B. (2013) Religious coping and quality of life among severely ill lung patients in a secular society. International Journal for the Psychology of Religion 23 (3): 188–203.

Pedersen, K. M., Andersen, J. S. and Søndergaard, J. (2012) General practice and primary health care in Denmark. Journal of the American Board of Family Medicine 25 (1): 34–38.

Pesut, B., Fowler, M., Taylor, E. J., Reimer-Kirkham, S. and Sawatzky, R. (2008) Conceptualising spirituality and religion for healthcare. Journal of Clinical Nursing 17 (21): 2803–2810.

Rosen, I. (2009) ‘I’m a Believer – but I’ll be Damned if I’m Religious’: Belief and Religion in the Greater Copenhagen Area – A Focus Group Study. Lund: Lunds Universitet.

Salander, P. (2012) The emperor’s new clothes: Spirituality. A concept based on questionable ontology and circular findings. Archive for the Psychology of Religion 34 (1): 17–32.

Smith, J. A., Flowers, P. and Larkin, M. (2009) Inter­pretative Phenomenological Analysis: Theory, Method and Research. London: Sage.

Sulmasy, D. P. (2002) A biopsychosocial-spiritual model for the care of patients at the end of life. Gerontologist 42 (3): 24–33.

Taylor, C. (2007) A Secular Age. Cambridge, MA: Harvard University Press.

Vermandere, M., Choi, Y. N., De Brabandere, H., Decouttere, R., De Meyere, E., Gheysens, E., Nickmans, B., Schoutteten, M., Seghers, L., Truijens, J., Vandenberghe, S., Van De Wiele, S., Van Oevelen, L. A. and Aertgeerts, B. (2012) GPs’ views concerning spirituality and the use of the FICA tool in palliative care in Flanders: A qualitative study. British Journal of General Practice 62 (603): 718–725.

Wear, D. and Castellani, B. (2000) The development of professionalism: Curriculum matters. Academic Medicine 75 (6): 602–611.

Zuckerman P. (2008) Society Without God. New York: New York University Press.


  • There are currently no refbacks.

Equinox Publishing Ltd - 415 The Workstation 15 Paternoster Row, Sheffield, S1 2BX United Kingdom
Telephone: +44 (0)114 221-0285 - Email:

Privacy Policy