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Too complex and time-consuming to fit in! Physicians' experiences of elderly patients and their participation in medical decision making: a grounded theory study
  1. Anne Wissendorff Ekdahl1,2,
  2. Ingrid Hellström1,2,
  3. Lars Andersson3,
  4. Maria Friedrichsen2,4
  1. 1Department of Geriatric Medicine, Vrinnevi Hospital, Norrköping, Sweden
  2. 2Department of Social and Welfare Studies, Faculty of Health Sciences, Linköping University, Norrköping, Sweden
  3. 3National Institute for the Study of Ageing and Later Life (NISAL), Department of Social and Welfare Studies, Linköping University, Norrköping, Sweden
  4. 4Palliative Education and Research Center, Vrinnevi Hospital, Norrköping, Sweden
  1. Correspondence to Dr Anne Wissendorff Ekdahl; anne.ekdahl{at}


Objective To explore physicians' thoughts and considerations of participation in medical decision making by hospitalised elderly patients.

Design A qualitative study using focus group interviews with physicians interpreted with grounded theory and completed with a questionnaire.

Setting and participants The setting was three different hospitals in two counties in Sweden. Five focus groups were conducted with physicians (n=30) in medical departments, with experience of care of elderly patients.

Results Physicians expressed frustration at not being able to give good care to elderly patients with multimorbidity, including letting them participate in medical decision making. Two main categories were found: ‘being challenged’ by this patient group and ‘being a small part of the healthcare production machine’. Both categories were explained by the core category ‘lacking in time’. The reasons for the feeling of ‘being challenged’ were explained by the subcategories ‘having a feeling of incompetence’, ‘having to take relatives into consideration’ and ‘having to take cognitive decline into account’. The reasons for the feeling of ‘being a small part of the healthcare production machine’ were explained by the subcategories ‘at the mercy of routines’ and ‘inadequate remuneration system’, both of which do not favour elderly patients with multimorbidity.

Conclusions Physicians find that elderly patients with multimorbidity lead to frustration by giving them a feeling of professional inadequacy, as they are unable to prioritise this common and rapidly growing patient group and enable them to participate in medical decision making. The reason for this feeling is explained by lack of time, competence, holistic view, appropriate routines and proper remuneration systems for treating these patients.

This is an open-access article distributed under the terms of the Creative Commons Attribution Non-commercial License, which permits use, distribution, and reproduction in any medium, provided the original work is properly cited, the use is non commercial and is otherwise in compliance with the license. See: and

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  • To cite: Ekdahl AW, Hellström I, Andersson L, et al. Too complex and time-consuming to fit in! Physicians' experiences of elderly patients and their participation in medical decision making: a grounded theory study. BMJ Open 2012;2:e001063. doi:10.1136/bmjopen-2012-001063

  • Contributors AWE drafted the manuscript, LA and MF participated in the design of the study and IH performed the qualitative analysis together with AWE and MF. All authors read and approved the final manuscript, which was then given a final review by an English language editor.

  • Funding This work was supported by the County Council of Eastern Östergötland, which financed salary costs for this study for AWE and MF. The study was funded by the Stahl Foundation, and the Swedish government supplied additional financial support through funding for medical training and research (ALF grants).

  • Competing interests None.

  • Ethics approval All doctors who participated in the interviews were informed about the aim of the study and that all participation was voluntary. They were also informed that the interviews would result in an article and that it would not be possible to connect specific statements to a named person.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement Extra data (interviews in full text) is available by emailing anne.ekdahl{at}