The details of the IRB/oversight body that provided approval or exemption for the research described are given below:Įthical approval for the study was gained from the University College London research ethics committee (Project ID 19031/001) I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. The authors have declared no competing interest. Ambiguity and contradictions were considered as both obstacles and benefits when deployed in practice and strategic considerations were important in deciding which to lean on. Clinicians cited moral issues at both individual and societal levels as integral to the conceptual basis and deployment of the functional-organic distinction and described actively navigating these as part of their work.Ĭonclusions There is a considerable distance between the status of the functional-organic distinction as a sound theoretical concept generalisable across conditions and its role as a gatekeeping tool within the structures of healthcare. These uses included helping communicate medical problems, navigating services, hiding meaning by making psychological explanations more palatable, tackling stigma, giving hope, and giving access to illness identity. The distinction was considered theoretically unsatisfactory, eventually to be superseded, but clinical decision-making required it to be used strategically. Contextual factors – including cultural assumptions, service demands, patient needs, and colleagues’ views – were key in how the distinction was deployed in practice. Organic factors were considered to be objective, unambiguously identifiable, and clearly causative, whereas functional causes were invisible and to be hypothesised through thinking and conversation. Results The distinction was described as often incongruent with how clinicians conceptualise patients’ problems.
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