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In this article we use an existential media framework to explore the asynchronous, written and digital form of GP-patient communication that takes place through e-consultations in a Danish general practice context. This approach acknowledges e-consultation as more than a tool for information delivery and frames GP and patient not as skilful media users but as dependent co-existers: Both thrown into and trying to navigate the digital healthcare ecology. Through a thematic analysis of 38 semi-structured qualitative interviews with patients and GPs we carve out three themes unpacking the existential dimensions of e-consultation: 1. Patient and GP are placed in a Culture of non-stop connectivity and we show the ambivalences arising herein fostering both relief, reassurance and new insecurities. 2. Ethical challenges of responsible co-existence points to dilemmas of boundary setting and caring for self and co-exister in the digital encounter. 3. We-experiences illustrates the potential of e-consultation to signal GP presence, even when the GP is silent. We also discuss the existential ethics of care emerging from the contemporary digital healthcare ecology and call for empirically grounded studies of the existential dimensions tied to encounters in contemporary digital care infrastructures.

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BACKGROUND: Since the COVID-19 pandemic, the use of video consultation (VC) in primary care has expanded considerably in many countries. VC and other telehealth formats are often touted as a solution to improved health care access, with numerous studies showing high satisfaction with this care format among health professionals and patients. However, operationalization and measurement of patient satisfaction with VC varies across studies and often lacks consideration of dynamic contextual factors (eg, convenience, ease-of-use, or privacy) and doctor-patient relational variables that may influence patient satisfaction. OBJECTIVE: We aim to develop a comprehensive and evidence-based questionnaire for assessing patient satisfaction with VC in general practice. METHODS: The vCare Patient-Satisfaction Questionnaire (the vCare-PSQ) was developed according to the COSMIN (Consensus-Based Standards for the Selection of Health Measurement Instruments) guidelines. To achieve our overall objective, we pursued three aims: (1) a validation analysis of an existing patient-satisfaction scale (the PS-14), (2) an assessment of extrinsic contextual factors that may impact patient satisfaction, and (3) an assessment of pertinent intrinsic and relational satisfaction correlates (eg, health anxiety, information technology literacy, trust in the general practitioner, or convenience). For validation purposes, the questionnaire was filled out by a convenience sample of 188 Danish adults who had attended at least 1 VC. RESULTS: Our validation analysis of the PS-14 in a Danish population produced reliable results, indicating that the PS-14 is an appropriate measure of patient satisfaction with VC in Danish patient populations. Regressing situational and doctor-patient relational factors onto patient satisfaction further suggested that patient satisfaction is contingent on several factors not measured by the PS-14. These include information technology literacy and patient trust in the general practitioner, as well as several contextual pros and cons. CONCLUSIONS: Supplementing the PS-14 with dynamic measures of situational and doctor-patient relational factors may provide a more comprehensive understanding of patient satisfaction with VC. The vCare-PSQ may thus contribute to an enhanced methodological approach to assessing patient satisfaction with VC. We hope that the vCare-PSQ format may be useful for future research and implementation efforts regarding VC in a general practice setting.

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OBJECTIVE: To explore possible challenges to General Practitioners' (GPs') interpersonal contact with patients in video consultations (VCs), and learn how they change their communication strategies to carry out medical work in a setting with altered sensory conditions. DESIGN, SETTING, SUBJECTS: The study included 6 GPs from the Copenhagen area, with different levels of experience of VC. The data consist of 6 interviews with GPs, held in 2021-2022. The semi-structured interviews included playback of a recorded VC between each GP and a patient, inspired by the Video-Stimulated Interview technique. Interviews were transcribed and analyzed using Interpretative Phenomenological Analysis (IPA). RESULTS: GPs experienced alterations in the sensation of their patients in VCs, and worried about missing something important, including assessing the patient. Generally, GPs felt that interpersonal contact was good enough for the purpose. GPs compensated for altered sensory conditions on video by asking more questions, repeating their advice, and meta-communicating. They used their senses of sight and hearing relatively more in VCs. Compensation also took the form of triage, so that consultations on sensitive topics or with new patients were not selected to take place on video. CONCLUSION AND IMPLICATIONS: By compensating for altered sensory conditions in VCs, GPs can carry out their medical work sufficiently well and sustain the best possible interpersonal contact. Our findings are useful for establishing ways to maintain good interpersonal contact between GPs and patients in VCs.

Video consultation (VC) implies new opportunities but appears to pose challenges in the communication between health professionals and patients.Altered sensory input affects interpersonal contact between doctors and patients and challenges the use of silent knowledge.Some GPs are concerned that they are unable to fully assess patients in VCs.GPs compensate verbally and non-verbally, and perform triage to keep interpersonal contact good enough for the purpose.

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In this paper we present findings from a qualitative ethnographic study investigating the experiences and perceptions of general practitioners and other practice staff when introducing a new point of care diagnostic test technology (point of care polymerase chain reaction (POC PCR)) in general practice in Denmark. The ethnographic study was conducted in five general practice clinics, involving observations in four of the clinics and interviews with general practitioners and practice staff in all five clinics. Following an initial analytic phase in which barriers and facilitators in the implementation process of the Point-of-Care test were identified, we developed theoretically informed themes, drawing upon Hartmut Rosa's social theory of technological acceleration. These themes included ambiguous experiences and perceptions of: (i) diagnostic specification and inflation embedded in diagnostic practices; (ii) empowerment and erosion of professional judgment; (iii) strategies of security and insecurity in communication; (iv) the interdependence between professional autonomy and economic structures associated with organizational power; and (v) subjective and organizational time. We discuss how diagnostic technologies simultaneously contribute to and disrupt treatment safety, efficiency, and medical decision-making. Using Rosa's sociological concepts of alienation and resonance, this article furthermore explores how these ambiguous dynamics are experienced in general practice settings. It also examines the implications of navigating a heterogeneous socio-technical and medical landscape and what it means to be a health professional in a contemporary general practice environment that is increasingly shaped by diagnostic technologies.

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BACKGROUND: Empathy is widely recognized as a multi-dimensional construct, involving emotional and cognitive components. These may cause distinct experiences and behaviors that can be both beneficial and deleterious to individuals' well-being and mental health. AIM: We wished to examine the association between emotional and cognitive empathy of Danish university students as measured by the multidimensional Interpersonal Reactivity Index (IRI) and study major, sex, age, and parental status. Additionally, we aimed to gauge the validity of the Jefferson Scale of Empathy - Student version (JSE-S) as a measure of primarily cognitive empathy in the context of medical majors by comparing JSE-S scores with IRI cognitive scores. METHODS: In our national, cross-sectional study, conducted in October 2020, we used survey data from students in their first, third, and final study year. All students from University of Southern Denmark were invited to fill out IRI, and all medical students at Denmark's four medical educations were additionally invited to fill out the JSE-S. Associations were estimated by linear regression models. RESULTS: Of 14,072 invited, 2,595 students completed the questionnaire. Health majors scored statistically significantly higher on cognitive empathy than students from other study majors. The JSE-S correlated significantly with the cognitive empathy subscales of the IRI. Furthermore, the effects found in relation to sex, age-, and parental status were significant. CONCLUSION: Our study results show that large differences in empathy exist between university students and study majors. Overall, our results highlight (1) the relevance of investigating empathy as a multidimensional versus a global construct in young adult populations (including university students) and (2) the importance of focusing on differences in empathy across different student characteristics.

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This article contributes to social health research by presenting an analysis of the temporal dimensions of the "good" doctor-patient relationship as perceived and enacted by patients and general practitioners (GPs). The empirical data derive from ethnographic fieldwork comprising participant observation in four general practice clinics in Denmark, and semi-structured interviews with 27 patients and eight GPs. The analysis draws from Michael Flaherty's sociology of time: notions of temporal agency and "time work" are used as analytical tools to demonstrate that the "good" doctor-patient relationship is constructed in a tension between external temporal structures and internal temporal experiences that are the result of GPs' and patients' agentic practices of "doing time." Thus, the findings illustrate how temporal determinism and self-determinism are equally interwoven when GPs and patients talk about, enact and seek meaningful temporal experiences within the doctor-patient relationship, while resisting and avoiding others that undermine the relationship. The results challenge 1. deterministic conceptions of time demands in today's healthcare systems that are said to control healthcare providers' behavior and 2. the taken-for-granted understanding of continuity as a resource in itself.

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This study uses socio-cognitive theory on technological frames to understand how and why general practitioners in Denmark use or choose not to use video consultations. Video consultations play a vital role in the digitalisation of the Danish healthcare system. Whilst political decision-makers continuously push for increased use of video consultations, uptake accounts for less than 2% of all consultations. Research is needed that explores the actual circumstances and conditions of video consultation use. Our data corpus consists of 30 semi-structured interviews conducted from August 2021 to August 2022 with 27 Danish general practitioners. Interviews were analysed following reflexive thematic analysis. Our findings show that video consultations are interpreted as 1) compromising occupational values, 2) a crisis tool, 3) the future, and 4) a tool to improve work conditions. Video consultations are differently adopted across clinics due to different interpretations of the technology and its relative advantage in specific clinical contexts. We argue that the concept of technological frames offers a useful analytic perspective for elucidating and anticipating attitudes and actions towards a technology. It increases our understanding of the uptake and rejection of video consultations. This knowledge is valuable for clinicians and politicians working with technological innovation in general practice.

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The aim of this study was to identify (i) emotions experienced by healthcare professionals (HCPs) after adverse or traumatic events and (ii) needs for support after adverse or traumatic events. Data for this qualitative, descriptive study were collected at 27 seminars for 198 HCPs introducing a peer-support programme after adverse or traumatic events (The Buddy Study). Through interactive exercises, participants shared their experiences, and this study reports on the responses of an exercise identifying emotions and needs after an adverse or traumatic event. The top five emotions were anger, guilt, impotence, grief, and frustration and anxiety, and the top five needs were to be met with understanding, recognition, listening, care, and respect. Ten categories of emotions experienced by HCPs after adverse or traumatic events were constructed, and the five categories with the highest number of mentions were anger and impotence, fear and insecurity, negative self-evaluation, guilt and shame, and alone and overloaded. Nine categories relating to needs for support after adverse or traumatic events were constructed, and the five categories with the highest number of mentions were: being seen and understood, compassion, being respected, time to recover, and organisational support. The emotional disclosure promoted at the peer seminars of the Buddy Study revealed that all participants share the same emotional distress, being either second victims or potential second victims. Moreover, the support needed was of a human-to-human nature that all participants felt capable of providing as a "buddy" for a colleague. Both the identified emotions and needs for support identified in this study may contribute to qualifying the development of the content of support programmes for HCPs after traumatic or adverse events.

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In the wake of the COVID-19 pandemic, video consultation was introduced in general practice in many countries around the world as a solution to provide remote health care to patients. It was assumed that video consultation would find widespread adoption in post-COVID-19 general practice. However, adoption rates remain low across countries in Northern Europe, suggesting that barriers to its use exist among general practitioners and other practice staff. In this viewpoint, we take a comparative approach, reflecting on similarities and differences in implementation conditions of video consultations in 5 Northern European countries' general practice settings that might have created barriers to its use within general practice. We convened at a cross-disciplinary seminar in May 2022 with researchers and clinicians from 5 Northern European countries with expertise in digital care in general practice, and this viewpoint emerged out of dialogues from that seminar. We have reflected on barriers across general practice settings in our countries, such as lacking technological and financial support for general practitioners, that we feel are critical for adoption of video consultation in the coming years. Furthermore, there is a need to further investigate the contribution of cultural elements, such as professional norms and values, to adoption. This viewpoint may inform policy work to ensure that a sustainable level of video consultation use can be reached in the future, one that reflects the reality of general practice settings rather than policy optimism.

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BACKGROUND: The modern medical education is predominantly grounded in the biomedical sciences. In recent years, medical humanities have been included into the medical curricula in many countries around the world one of the objectives being to promote patient-centred, empathic care by future physicians. Studies have been made of the impact of inclusion of medical humanities components within the medical curriculum. Although some results suggest increased empathy, others remain inconclusive. To gain insight into the depth, context, and impact of inclusion of the medical humanities for future physicians, this study aimed to explore Danish medical students' understanding of and reflections on how the medical humanities relate to the medical education, including the clinic. METHODS: We conducted a qualitative research study, involving semi-structured interviews with twenty-three Danish medical students across years of curriculum and medical schools. Interviews were recorded, transcribed verbatim and analyzed using Braun and Clarke's thematic analysis. RESULTS: The findings demonstrate the subordinate role of the medical humanities in the medical educational system. Students prioritize biomedical knowledge building in the preclinical curriculum, partly as a reaction to an unbalanced institutional inclusion of the medical humanities. Observing how structural empathy incentives are lacking in the clinical curriculum, the values inherent in the medical humanities are undermined. CONCLUSION: Danish medical students become part of an educational environment with lacking institutional conditions and structures to promote the strong inclusion of the medical humanities. A focus is therefore needed on the values, norms and structures of the medical educational systems that undermine a strong inclusion of the medical humanities into medical education.

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BACKGROUND: Clinical empathy has been associated with a range of positive patient- and clinician outcomes. Educating medical students to become empathic physicians has in recent years become a clearly pronounced learning objective in medical education in many countries worldwide. Research knowledge about how medical students experience the learning processes conveyed by empathy-enhancing educational interventions is lacking. Our study aimed to explore Danish medical students' perspectives on which experiences allowed learning processes to take place in relation to empathy and empathic communication with patients. METHODS: We conducted a qualitative research study, involving semi-structured interviews with twenty-three Danish medical students across years of curriculum and universities. Braun and Clarke's reflexive thematic analysis (RTA) guided the analytical process, moving on a continuum from inductive to deductive, theoretical approaches. Key concepts in regard to learning processes deriving from Amadeo Giorgi's learning theory were applied to analyse the data. RESULTS: Learning processes in relation to clinical empathy occured: 1. when theoretical knowledge about empathy became embodied and contextualied within a clinical context 2. through interpersonal interactions, e.g., with peers, faculty members and clinicians, that conveyed behavior-mobilizing positive and negative affect and 3. when new learning discoveries in 2. and 3. were appropriated as a personalized and adequate behavior that transcends the situational level. CONCLUSION: Rather than being an immediate product of knowledge transmission, skill acquisition or training, learning clinical empathy is experienced as a dynamic, temporal process embedded in a daily clinical lifeworld of becoming an increasingly human professional.

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Objective: To analyse how the patient's use of handheld technology in video consultations with their general practitioner affects communication and the possibilities for the delivery of quality healthcare. Focusing on the visually communicated aspects of the video consultation, we present three episodes from our recordings of eight video consultations between Danish general practitioners and patients. Methods: Using a multimodal social semiotic framework to conduct a micro-level analysis, we present episodes from our data in which the hardware's affordance of mobility gave rise to salient events in the interactions of patients who used handheld devices to carry out their video consultations. Results: Patients' use of technology plays a significant role in the interactions between general practitioner and patient and is thus an important factor to consider in how practice is shaped when using handheld video consultation technology. Conclusions: Our findings demonstrate that the mobility of handheld devices (smartphone, tablet) can be used to augment sensing and embodiment and enhance the delivery of healthcare in video consultations. However, mobility may also disrupt the interaction. As a result, possibilities for the delivery of quality healthcare lie quite literally in the patients' hands.

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BACKGROUND: Uncertainties are omnipresent in health care, but little is known about general practitioners' (GPs) professional uncertainties concerning digital consultations. This is problematic, as many countries have undergone an extensive digital transformation. OBJECTIVE: The aim of this study was to explore the professional uncertainties that emerged among Danish GPs with the introduction of video consultations. METHODS: We conducted qualitative interviews with 15 Danish GPs during the beginning of the COVID-19 pandemic in 2020. The interviews were analyzed using an abductive approach. RESULTS: We identified 3 categories of uncertainty: integrity, setting, and interaction. Respectively, these 3 categories of uncertainty refer to (1) uncertainties related to how technology may impede the provision of health care; (2) uncertainties related to the potentials of video technology; and (3) uncertainties related to how the video consultation technology affects interactions with patients. CONCLUSIONS: The uncertainties experienced by Danish GPs appear to be a typical reaction to the introduction of new technology. Embedding video consultation technology into GPs' working routines will take time, and GPs do not necessarily feel intuitively capable of transferring their abilities, such as being good and socially present for video-mediated consultations. The heterogeneity of professional uncertainties experienced among the GPs suggests that they are the product of individual GP-technology relationships-not of the technology in itself. Consequently, we cannot expect that uncertainties can be remedied by changing or precluding new technology.

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BACKGROUND: Professional empathy has been associated with a range of positive patient- and clinician outcomes and is therefore considered important to develop for future physicians. Measuring changes in empathy scores among medical students by using the Jefferson Scale of Empathy (Student version) (JSE-S) has led to mixed results. So far, no investigation of Danish medical students' empathy development has been conducted. The aim of this study was therefore to examine the associations between empathy scores among Danish medical students and medical school, year of curriculum, age, sex, co-habitation, and parental status, specialty preferences and motivations for choosing medicine as a future profession. METHODS: This was a cross-sectional questionnaire study. All medical students from four medical schools in Denmark in their first, third and sixth year (N = 4,178) were invited to participate in the study in October 2020. The associations between JSE-S sum score and the above explanatory factors were analysed by uni- and multivariable linear regression models. RESULTS: The JSE-S was completed by 672 medical students. The overall mean score was 112.7. There were no statistically significant differences in empathy between medical schools, first, third- and sixth- year medical students, age groups or parental status. Female students and students living with a spouse or partner scored higher on JSE-S than male students or students living alone, and the sex difference remained statistically significant in the multivariable regression. In both the univariable and multivariable setting, preference for future medical specialty was statistically significant, with a decrease in scores for students choosing surgery-specialties. Motivational factors were not statistically significantly associated with empathy, although there was a slight upwards trend for one of the motivational categories, named "personal experiences". CONCLUSIONS: Overall, our results showed neither decrease nor increase but instead rather stable empathy scores across years of curriculum of medical students in Denmark, adding to the mixed picture of empathy development among medical students. Our findings are consistent with positive associations found in international studies between empathy scores and higher age, female sex, specialty preferences for psychiatry and general practice and altruistic motivations for choosing to enroll. Although specialty preferences are changing during medical education, they may be used meaningfully as predictors of individual student empathy levels.

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OBJECTIVE: To explore the experiences of Danish patients using video consultation (VC) to consult their general practitioner (GP) during COVID-19 lockdown and their attitudes towards continued use beyond COVID-19. DESIGN: A qualitative design was employed, consisting of individual semi-structured interviews where participants were asked to retrospectively describe their experiences and reflections. Data were analysed using thematic analysis. SETTING: Capital and Southern Regions of Denmark. PARTICIPANTS: 27 patients (17 women and 10 men) aged between 23 and 76 years who had used VC once or more during the COVID-19 pandemic participated. The data were collected from February to October 2020. We used a convenience sampling technique and sample size was based on the principle of information power. RESULTS: Three overarching themes, each containing subthemes, were developed. Participants described pre-use reactions and concerns relating to VC as being 'better than nothing' given the COVID-19 circumstances, and preferred VC over a telephone consultation. Salient pre-use concerns related to whether the technology 'would work' and whether VC would influence consultation length and GP behaviour. Overall, participants reported positive experiences of VC use and communication attributing these mainly to 'knowing the GP' and 'feeling seen and heard'. Participants were interested in future VC use for many needs as a natural consequence of an increasingly digitalised society, not least due to COVID-19. CONCLUSIONS: Our findings contribute with knowledge about first-user experiences of VC against the background of COVID-19. Participants showed positive attitudes towards future use of VC as either a supplementary or alternative consultation form in general practice.

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OBJECTIVES: Defensive medicine has originally been defined as motivated by fear of malpractice litigation. However, the term is frequently used in Europe where most countries have a no-fault malpractice system. The objectives of this systematic review were to explore the definition of the term 'defensive medicine' in European original medical literature and to identify the motives stated therein. DESIGN: Systematic review. DATA SOURCES: PubMed, Embase and Cochrane, 3 February 2020, with an updated search on 6 March 2021. METHODS: Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses, we reviewed all European original peer-reviewed studies fully or partially investigating 'defensive medicine'. RESULTS: We identified a total of 50 studies. First, we divided these into two categories: the first category consisting of studies defining defensive medicine by using a narrow definition and the second category comprising studies in which defensive medicine was defined using a broad definition. In 23 of the studies(46%), defensive medicine was defined narrowly as: health professionals' deviation from sound medical practice motivated by a wish to reduce exposure to malpractice litigation. In 27 studies (54%), a broad definition was applied adding … or other self-protective motives. These self-protective motives, different from fear of malpractice litigation, were grouped into four categories: fear of patient dissatisfaction, fear of overlooking a severe diagnosis, fear of negative publicity and unconscious defensive medicine. Studies applying the narrow and broad definitions of defensive medicine did not differ regarding publication year, country, medical specialty, research quality or number of citations. CONCLUSIONS: In European research, the narrow definition of defensive medicine as exclusively motivated by fear of litigation is often broadened to include other self-protective motives. In order to compare results pertaining to defensive medicine across countries, future studies are recommended to specify whether they are using the narrow or broad definition of defensive medicine. PROSPERO REGISTRATION NUMBER: CRD42020167215.

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"The existential" is a concept that many people use albeit associated with different meanings. In order to increase research-based insight into the meaning of "the existential," we conducted a questionnaire study in Denmark in 2018 in which we asked 1.106 Danes of various age, gender, educational and geographical background about personal associations linked to "the existential." Factor analysis of the answers resulted in three different groups of meaning: (1) essential meanings of life, (2) spirituality/religiosity and (3) existential thinking. The findings show that "the existential" serves well as an overarching construct potentially including secular, spiritual and religious meaning domains, at least within the European context.

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BACKGROUND: The COVID-19 pandemic has changed various spheres of health care. General practitioners (GPs) have widely replaced face-to-face consultations with telephone or video consultations (VCs) to reduce the risk of COVID-19 transmission. Using VCs for health service delivery is an entirely new way of practicing for many GPs. However, this transition process has largely been conducted with no formal guidelines, which may have caused implementation barriers. This study presents a rapid cycle coproduction approach for developing a guide to assist VC implementation in general practice. OBJECTIVE: The aim of this paper is to describe the developmental phases of the VC guide to assist general practices in implementing VCs and summarize the evaluation made by general practice users. METHODS: The development of a guide for VC in general practice was structured as a stepped process based on the coproduction and prototyping processes. We used an iterative framework based on rapid qualitative analyses and interdisciplinary collaborations. Thus, the guide was developed in small, repeated cycles of development, implementation, evaluation, and adaptation, with a continuous exchange between research and practice. The data collection process was structured in 3 main phases. First, we conducted a literature review, recorded observations, and held informal and semistructured interviews. Second, we facilitated coproduction with stakeholders through 4 workshops with GPs, a group interview with patient representatives, and individual revisions by GPs. Third, nationwide testing was conducted in 5 general practice clinics and was followed by an evaluation of the guide through interviews with GPs. RESULTS: A rapid cycle coproduction approach was used to explore the needs of general practice in connection with the implementation of VC and to develop useful, relevant, and easily understandable guiding materials. Our findings suggest that a guide for VCs should include advice and recommendations regarding the organization of VCs, the technical setup, the appropriate target groups, patients' use of VCs, the performance of VCs, and the arrangements for booking a VC. CONCLUSIONS: The combination of coproduction, prototyping, small iterations, and rapid data analysis is a suitable approach when contextually rich, hands-on guide materials are urgently needed. Moreover, this method could provide an efficient way of developing relevant guide materials for general practice to aid the implementation of new technology beyond the pandemic period.

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In recent years and throughout the developed world, policymakers have encouraged the implementation of digital patient-clinician interaction. Our focus is on the Danish general practice setting where email consultations were implemented as a mandatory service in 2009 and now constitute 21% of all consultations in general practice. Drawing upon strong structuration theory (SST), our analysis sets out to explore how email consultations are represented in structures on macro, meso and micro-levels and how the interplay between structures and agents plays out with respect to possible alignments, tensions and adjustments. We analyze data from policy documents on the macro and meso-levels, data from clinics' websites (meso-level) and data from interviews with GPs and patients (micro-level) (n = 53). Our findings show that the introduction of email consultation as a new health technology is a key site for development in email consultation practice, professional boundary setting and adjustments within the doctor-patient relationship. Our findings thus demonstrate that email consultation can be considered a dynamic component of a socio-technical network rather than a static medium for simple health transactions or information delivery. Based on these findings, we recommend that, for future implementation of patient-clinician digital communication it is important to investigate the multiple sources of influence on telecare practices and to see its intended users as agents who actively shape their own care motivated by opinions, relationships and values.

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The aim of this article is to show how Jürgen Habermas' communicative action theory serves as a useful tool in analysing and interpreting empirical data on how Danish general practitioners experience defensive medicine in their everyday working life. Through six qualitative focus group interviews with a total of 28 general practitioners (14 men and 14 women), the general practitioners' understandings of and experiences with defensive medicine were unfolded and discussed. Traditionally, defensive medicine is understood as physicians' deviation from sound medical practice due to fears of liability claims or lawsuits. In this study, however, a broader understanding of defensive medicine emerged as unnecessary medical actions that are more substantiated by feelings of demands and pressures than meaningful clinical behaviour. As a first analytical step, the data are contextualized drawing on the medical sociological literature that has theorized recent changes within primary health care such as regulation, audit, standardization and consumerism. Using Habermas' theorization to further interpret the general practitioners' experiences, we argue that central areas of the general practitioners' clinical everyday work life can be seen as having become subject to the habermasian social and political processes of 'strategic action' and 'colonization'. It is furthermore shown that the general practitioners share an impulse to resist these colonizing processes, hereby pointing to a need for challenging the increasingly defensive medical culture that seems to pervade the organization of general practice today.

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