Conflict, collusion or collaboration in consultations about medically unexplained symptoms: The need for a curriculum of medical explanation
Conflict, collusion or collaboration in consultations about medically unexplained symptoms: The need for a curriculum of medical explanation
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DOI：
10.1016/j.pec.2007.03.008
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发表时间：
2007-08-01
影响因子：
3.5
通讯作者：
Salmon, Peter
中科院分区：
文献类型：
--
作者：
Salmon, Peter
目的：探讨医学上不明原因症状(MU)会诊中沟通问题的基础，并探讨其对临床教育的启示。方法：对近年来有关MU临床沟通细节的研究进行了叙述性和批判性的综述，并从从业者的角度对更广泛的研究文献进行了梳理。结果：关于MU的会诊往往涉及患者权威和从业者权威之间的竞争，前者基于患者对症状的了解，后者基于正常的测试和调查结果。因此，会诊的结果可能取决于每一方用来施加权威的策略，而不是临床需要。结论：竞赛是患者和从业者占据单独的概念性‘地盘’的产物。避免竞争需要实践者找到共同的概念基础，在这个基础上各方可以理解和讨论症状。通过与患者建议的解释合谋来寻找共同点，可能会损害临床关系。相反，从业者需要从现有的医学和非专业材料中设计出双方都能接受的解释。实践影响：尽管从业者通常会做出这样的解释，但他们的专业角色的这一方面似乎在从业者或医学课程中并不是很受重视。临床教育课程可以包括症状解释课程，借鉴医学、心理学和人类学的研究成果。(C)2007爱思唯尔爱尔兰有限公司。保留所有权利。
Objective: To identify the basis of the communication problems that characterise consultations about medically unexplained symptoms (MUS) and to identify implications for clinical education.Method: Recent research into the details of clinical communication about MUS was reviewed narratively and critically, and broader research literature was scrutinised from the perspective of a practitioner who wishes to provide patients with explanations for such symptoms.Results: Consultations about MUS often involve contest between patients' authority, resting on their knowledge of their symptoms, and practitioners' authority, based on the normal findings of tests and investigations. The outcome of consultations can therefore depend on the strategies that each party uses to press their authority, rather than on clinical need.Conclusion: Contest is a product of patients and practitioners occupying separate conceptual 'ground'. Avoiding contest requires the practitioner to find common conceptual ground within which each party can understand and discuss the symptoms. Finding common ground by collusion with explanations that patients suggest can damage clinical relationships. Instead the practitioner needs to fashion explanation that is acceptable to both parties from available medical and lay material.Practice implications: Although practitioners commonly fashion such explanations, this aspect of their professional role seems not to be greatly valued amongst practitioners or in medical curricula. Clinical education programmes could include curricula in symptom explanation, drawing from research in medicine, psychology and anthropology. (C) 2007 Elsevier Ireland Ltd. All rights reserved.