‘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.


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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