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


  • Elisabeth Assing Hvidt University of Southern Denmark
  • Jens Søndergaard University of Southern Denmark
  • Dorte Gilså Hansen University of Southern Denmark
  • Pål Gulbrandsen Akershus University Hospital
  • Jette Ammentorp Lillebælt Hospital
  • Connie Timmermann University of Southern Denmark
  • Niels Christian Hvidt University of Southern Denmark




biopsychosocial-existential, general practice, physician-patient communication, spiritual


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.

Author Biographies

Elisabeth Assing Hvidt, University of Southern Denmark

Elisabeth Assing Hvidt is a sociologist of religion, and she received her PhD in humanistic health research from the University of Southern Denmark. Her research interests include existential and spiritual aspects to illness, modern belief systems and relationships in healthcare.

Jens Søndergaard, University of Southern Denmark

Jens Søndergaard has a PhD from the University of Southern Denmark and is currently director of the Research Unit of General Practice at the University of Southern Denmark. He has authored or co-authored more than 150 peer-reviewed scientific papers published in international medical journals.

Dorte Gilså Hansen, University of Southern Denmark

Dorte Gilså Hansen received her PhD from the University of Southern Denmark in 2004 and she is currently Associate Professor and Head of the National Research Center for Cancer Rehabilitation. Her research areas include physical, psychosocial and existential problems caused by life-threatening diseases, rehabilitation and individual needs assessment.

Pål Gulbrandsen, Akershus University Hospital

Pål Gulbrandsen is a former general practitioner, now Professor of Health Services Research at the University of Oslo, Norway. His major research areas are clinical communication, psychosocial issues and the doctor–patient relationship. He has published more than 90 original papers, edited a book on shame in the medical encounter and authored a textbook on clinical communication, both in Norwegian.

Jette Ammentorp, Lillebælt Hospital

Jette Ammentorp is a Professor of Communication. Her main research interest is patient communication, patient experiences and empowerment of patients, with a special focus on methods to improve the communication between healthcare professionals and patients.

Connie Timmermann, University of Southern Denmark

Connie Timmermann obtained her PhD in Nursing from the University of Aarhus and she is currently employed as a postgraduate in patient-centered cancer care at IRS/University of Southern Denmark and Vejle Hospital. A common thread throughout her research is a focus on and discussion of existential resources and concerns of patients and their relatives.

Niels Christian Hvidt, University of Southern Denmark

Niels Christian Hvidt is a Danish theologian and humanistic health researcher, trained in Copenhagen and Rome. His research areas include spirituality and health, spiritual care, patient perspectives, ecumenical theology, theology of miracles and theology of prophecy.


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. https://doi.org/10.1136/jme.2010.041988

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. https://doi.org/10.1016/S0738-3991(03)00146-0

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. https://doi.org/10.1016/j.socscimed.2015.01.037

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. https://doi.org/10.1111/ecc.12097

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. https://doi.org/10.1080/02813432.2016.1249064

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. https://doi.org/10.1370/afm.245

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. https://doi.org/10.1016/j.pec.2013.11.004

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. https://doi.org/10.1177/104990910402100607

Coulehan, J. and Williams, P. C. (2003) Conflicting professional values in medical education. Cam­bridge Quarterly of Healthcare Ethics 12 (1): 7–20. https://doi.org/10.1017/S0963180103121032

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. https://doi.org/10.1093/fampra/cmu080

Dyer, A. R. (2011) The need for a new ‘new medical model’: A bio-psychosocial-spiritual model. Southern Medical Journal 104 (4): 297–298. https://doi.org/10.1097/SMJ.0b013e318208767b

Engel, G. L. (1977) The need for a new medical model: A challenge for biomedicine. Science 196 (4286): 129–136. https://doi.org/10.1126/science.847460

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: http://www.gallup.com/poll/142727/Religiosity-Highest-World-Poorest-Nations.aspx-1.

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. https://doi.org/10.3109/0284186X.2012.744141

Kirkeministeriet. (2016) Folkekirkens medlemstal. Retrieved from: http://www.km.dk/folkekirken/kirkestatistik/folkekirkens-medlemstal/.

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. https://doi.org/10.1080/13674670802024107

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. https://doi.org/10.1016/j.socscimed.2010.06.024

Liamputtong, P. (2011) Focus Group Methodology: Principle and Practice. London: Sage. https://doi.org/10.4135/9781473957657

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. https://doi.org/10.1111/j.1467-9566.2007.01057.x

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. https://doi.org/10.1080/10508619.2012.728068

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. https://doi.org/10.3122/jabfm.2012.02.110216

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. https://doi.org/10.1111/j.1365-2702.2008.02344.x

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. https://doi.org/10.1163/157361212X645241

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. https://doi.org/10.1093/geront/42.suppl_3.24

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. https://doi.org/10.3399/bjgp12X656865

Wear, D. and Castellani, B. (2000) The development of professionalism: Curriculum matters. Academic Medicine 75 (6): 602–611. https://doi.org/10.1097/00001888-200006000-00009

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



How to Cite

Assing Hvidt, E., Søndergaard, J., Hansen, D. G., Gulbrandsen, P., Ammentorp, J., Timmermann, C., & Hvidt, N. C. (2018). ‘We are the barriers’: Danish general practitioners’ interpretations of why the existential and spiritual dimensions are neglected in patient care. Communication and Medicine, 14(2), 108–120. https://doi.org/10.1558/cam.32147