Qualitative study of interpretation of reassurance among patients attending rheumatology clinics: "just a touch of arthritis, doctor?"
Qualitative study of interpretation of reassurance among patients attending rheumatology clinics: "just a touch of arthritis, doctor?"
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DOI：
10.1136/bmj.320.7234.541
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发表时间：
2000-02-26
影响因子：
105.7
通讯作者：
Blake, DR
中科院分区：
文献类型：
--
作者：
Donovan, JL;Blake, DR
目的研究临床医生常用的安慰方法，并探讨其对患者的影响。设计定性研究，对患者在咨询前后以及他们与医生的咨询进行深入的半结构化访谈。设置英国两个大城市的NHS风湿病专家诊所。参与者35名患者，由咨询风湿病专家从全科医生转诊信中选择（28名女性，7名男性; 24名患有炎症性关节病，ii其他风湿性疾病）.主要结果测量Patients' perceptions of reassurance. ResultsRelaissance是会诊的重要组成部分，无论诊断是明确的还是不确定的。临床医生试图通过强调疾病的轻度、早期或非严重性以及患者康复的可能性来减少焦虑。患者在他们自己的观点和感知的背景下解释安慰。医生强调病情的轻微或早期，这引起了对未来疼痛和残疾的恐惧，而不是提供保证。患者感觉;结论典型的安慰模式并不成功，因为患者和医生的观点不同。成功的保证的关键似乎是医生能够承认病人对他们困难的看法。
Objectives To examine commonly used methods of reassurance by clinicians and explore their effect on patients.Design Qualitative study of tape recordings of in-depth, semistructured interviews with patients before and after consultation and of their consultations with doctors.Setting NHS specialist rheumatology clinics in two large British cities.Participants 35 patients selected by consultant rheumatologists from general practitioner referral letters (28 women, 7 men; 24 with inflammatory arthropathies, ii other rheumatological complaints).Main outcome measures Patients' perceptions of reassurance.Results Reassurance was an important part of consultations, whether the diagnosis was clear or uncertain. Clinicians tried to reduce anxiety by emphasising the mildness, early stage, or non-seriousness of the disorder and the likelihood that patients would recover. Patients interpreted reassurance in the context of their own views and perceptions. Doctors' emphasis on the mildness or earliness of the condition raised the spectre of future pain and disability rather than providing reassurance. Patients who felt;hat their problems were properly acknowledged felt more reassured.Conclusions Typical patterns of reassurance were not successful because of the differences in perspective of patients and doctors. A key to successful reassurance seemed to be the doctor's ability to acknowledge patients' perspectives of their difficulties.