Why reassurance fails in patients with unexplained symptoms -: An experimental investigation of remembered probabilities
Why reassurance fails in patients with unexplained symptoms -: An experimental investigation of remembered probabilities
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DOI：
10.1371/journal.pmed.0030269
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发表时间：
2006-08-01
期刊：
影响因子：
15.8
通讯作者：
Rueddel, Heinz
中科院分区：
文献类型：
--
作者：
Rief, Winfried;Heitmueller, Andrea Maren;Rueddel, Heinz
提供安慰是医生最常用的口头干预之一。然而，医疗保障可能会失败，甚至产生负面影响。这是常见的情况下，在患者的医学上无法解释的症状。据推测，这些患者比其他组的患者更有可能不正确地回忆起由医生提供的医疗解释的可能性。方法和结果33例医学上无法解释的症状，22例重度抑郁症患者，和30名健康对照听了一个录音的医疗报告，以及两个控制报告。在听完报告后，参与者被要求对医生认为的投诉由特定医疗条件引起的可能性进行评估。尽管医生在口头报告中拒绝了大多数对症状的医学解释，但患有医学无法解释的投诉的患者记得更高的可能性。其他组和对照组患者之间无差异。当被要求想象的报告是适用于自己，多个医疗投诉的患者报告更多的关注他们的健康状况比个人在其他groups.Conclusions医生应该知道，患者的医学上无法解释的症状回忆医疗原因的可能性，他们的投诉不正确。因此，医师应通过询问和要求总结等方式来验证正确理解，以提高再保证的效果。
Background Providing reassurance is one of physicians' most frequently used verbal interventions. However, medical reassurance can fail or even have negative effects. This is frequently the case in patients with medically unexplained symptoms. It is hypothesized that these patients are more likely than patients from other groups to incorrectly recall the likelihoods of medical explanations provided by doctors.Methods and Findings Thirty-three patients with medically unexplained symptoms, 22 patients with major depression, and 30 healthy controls listened to an audiotaped medical report, as well as to two control reports. After listening to the reports, participants were asked to rate what the doctor thinks the likelihood is that the complaints are caused by a specific medical condition.Although the doctor rejected most of the medical explanations for the symptoms in his verbal report, the patients with medically unexplained complaints remembered a higher likelihood for medical explanations for their symptoms. No differences were found between patients in the other groups, and for the control conditions. When asked to imagine that the reports were applicable to themselves, patients with multiple medical complaints reported more concerns about their health state than individuals in the other groups.Conclusions Physicians should be aware that patients with medically unexplained symptoms recall the likelihood of medical causes for their complaints incorrectly. Therefore, physicians should verify correct understanding by using check-back questions and asking for summaries, to improve the effect of reassurance.