Consultations involving people with congenital disabilities: factors that help or hinder giving care

Background. Previous studies have suggested that the attitudes of health professionals towards people with disability may be as negative as those of society. Further, even positive attitudes may not always be reflected in the health professional's behaviour. Objective. The aim of this study was to examine GPs' (registrars and trainers) consultations with people who have congenital disabilities and to explore incidents when their attitudes were either matched or not matched with their behaviour. Methods. A purposeful sample of 19 registrars and trainers participated in a semi-structured interview using the critical incident technique. Subjects were asked to describe encounters from their professional life with a person with a congenital disability, when they either had or had not been able to behave as they wished. Results. The results indicated that matching or non-matching between attitudes and behaviour was related to three main themes: aspects of the patient such as their appearance, ease of communication and autonomy; aspects of the GP including their management of personal, expert and professional boundaries and the historical context of the consultation including the GP's personal and professional experience, the familiarity between the GP and the patient and the patient's previous experiences of care. Conclusion. The critical incident technique was found to be a useful tool to gain access into this complex and problematic area and the results raise many issues pertinent to the planning of learning opportunities for both undergraduates and postgraduates.