Balancing medical accuracy and diagnostic consequences: diagnosing medically unexplained symptoms in primary care
Balancing medical accuracy and diagnostic consequences: diagnosing medically unexplained symptoms in primary care
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DOI：
10.1111/1467-9566.12581
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发表时间：
2017-09-01
影响因子：
2.9
通讯作者：
Rasmussen, Erik B.
中科院分区：
文献类型：
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作者：
Rasmussen, Erik B.
本文重点关注医学上无法解释的症状 (MUS) 的病例，探讨在缺乏生物医学证据或其他强有力的医学诊断依据的情况下的诊断分类。这些数据来自 2015 年对挪威全科医生 (GP) 进行的三场焦点小组访谈，重点讨论了 MUS 使用（或不使用）哪些诊断的问题。定性分析重建了全科医生诊断账户的逻辑，其中心是诊断类别的含义以及预测其他人对这些含义的反应（称为“预期诊断”）。分析表明，全科医生通过平衡无根据的医疗准确性和预期的有害诊断后果来做出诊断；诊断的目标是在国际初级保健分类中找到能够产生可接受结果的类别，而不会在此过程中欺骗全科医生。利用诊断作为分类和分类之间的区别，讨论了研究结果及其与医学社会学的相关性。与经常被描述为无法诊断的疾病相反，该分析显示了全科医生如何在诊断分类的官僚意义上诊断 MUS——社会学观点中一直缺少这种感觉。
Focusing on the case of medically unexplained symptoms (MUS), this article explores diagnostic classification in the absence of biomedical evidence or other strong medical warrants for diagnosis. The data are from three focus group interviews with Norwegian general practitioners (GPs) conducted in 2015, that centred on the issue of what diagnoses to use (or not) for MUS. The qualitative analysis reconstructs the logic underlying GPs' diagnostic accounts, which centred on the meaning of diagnostic categories and on anticipating how generalised others' would respond to those meanings (called diagnosing by anticipation'). The analysis suggests that GPs confer diagnoses by balancing unwarranted medical accuracy and anticipated harmful diagnostic consequences; the goal of diagnosis was finding categories in the International Classification of Primary Care that would yield acceptable results, without making a liar of the GP in the process. Drawing on the distinction between diagnosis as colligation and classification, the findings and their relevance for medical sociology are discussed. Counter to frequent descriptions as illness that cannot be diagnosed', the analysis shows how GPs can diagnose MUS in the bureaucratic sense of diagnosis as classification - a sense that has been missing from sociological view.