What Is a Disease for Doctors? A Realist Thematic Qualitative Analysis of the Interpretation of Clinical Vignettes

TL;DR

This study explores how doctors decide if a condition qualifies as a disease, revealing diverse interpretations based on various factors.

Contribution

The paper introduces a realist thematic analysis of doctors' interpretations of clinical vignettes to understand disease categorization.

Findings

Doctors use a mix of objective, subjective, and socially mediated information to determine if a condition is a disease.

Four themes emerged: temporal dimension, reification, existential condition, and motivation to action.

Interpretations were highly variable, indicating no shared prototypical concept of disease among physicians.

Abstract

Given the long-standing debate about the nature of the concept of disease, the objective of this study was to understand how doctors categorize a condition as a disease or not, and what the kind of information they use is. A survey with a set of eighteen clinical vignettes was designed, and nineteen physicians and senior students purposefully selected were asked to interpret those situations as diseases or not and to produce an anonymous short written piece of text providing the motivation of their choice. Realist thematic analysis was used to analyse the answers, and four themes emerged: the temporal dimension of a disease, reification of disease, disease as an existential condition, and disease as a motivation to action. The respondents’ interpretations were very heterogeneous, supporting the idea that physicians do not share a common prototypical concept of disease. The results suggested that the interpretation of a condition as a disease or not is the final outcome of a process, in which information from objective, subjective, and socially mediated elements is taken into consideration. According to a critical realist and systemic approach, we hypothesize that the context of doctor–patient relationship could influence the interpretation of the same condition as being a disease or not.