Making a Difference. A study examining the experience of doctors working in A & E in treating people who present with self-mutilation

In this thesis I present the results of a grounded theory analysis of the
experiences of doctors working in Accident & Emergency (A&E) in treating
people who self-mutilate.
An overview of the literature examines the different terminologies used and the
different meanings and explanations for self-mutilation which are held by the
public, medical professionals and those working in the field of mental health, as
well as those who self-mutilate, all of which overlap and influence one another. In
this context I examine the limited literature investigating health professionals'
responses to self-mutilation. Negative attitudes and emotional responses are
often reported. The present study sought to investigate the specific experiences
of junior doctors working in an inner-London A&E. Eight participants were
interviewed to produce rich data which was analysed using grounded theory
methodology, in order to provide an in-depth understanding of their experiences.
The analysis highlighted the significance of working in the social context of A&E,
and of perceptions of the role of doctor, both of which influenced participants'
experiences in every aspect of their work. In particular participants reported
wanting to 'make a difference' which was generally seen as having a positive
impact upon health outcome. Participants generally believed that they could not
'make a difference' when treating patients who had self-mutilated, except in the
unusual instance where they felt that they had been able to engage the patient.
This experience had a negative impact on their emotional response to this patient
group and the degree to which they felt rewarded.
The findings are discussed in relation to the literature and a critical review of the
study is presented. Implications of the study are outlined, which include
recommendations for further training and for service provision.

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