Patients' perceptions of medical explanations for somatisation disorders: qualitative analysis
Patients' perceptions of medical explanations for somatisation disorders: qualitative analysis
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DOI：
10.1136/bmj.318.7180.372
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发表时间：
1999-02-06
影响因子：
105.7
通讯作者：
Stanley, I
中科院分区：
文献类型：
--
作者：
Salmon, P;Peters, S;Stanley, I
目的从患者的角度描述，设计患者叙述医生对其症状的解释的访谈的逐字记录的定性分析。设置在进入治疗方案之前，对利物浦、圣海伦和诺斯利的一般实践中提到的具有持续性躯体化症状的患者进行访谈。受试者对324名转诊患者中的228名进行了访谈。初步的访谈被用来开发的过程和技术，并最终分析的基础上的一个子样本的G8记录，随机选择的188名受试者的成绩单随后进行了访谈。分析表明，医学解释可以分为三类，根据病人的看法来定义。大多数解释都被认为是拒绝接受症状的现实。中间类别包括被视为串通的解释，其中医生默许患者自己的生物医学理论。然而，一些解释被病人认为是有形的，开脱的，和涉及。这些解释经历了病人满意和empowering.Conclusions躯体化障碍患者感到满意，并授权的医疗解释是有形的，开脱，并涉及。有力的解释可以改善这些患者的健康状况，并有助于减少他们对医疗服务的高要求。
Objectives To describe, from the perspective of patients, distinguishing features of doctors' attempts to explain the symptoms of somatisation disorders.Design Qualitative analysis of verbatim records of interviews in which patients recounted doctors' explanations of their symptoms.Setting Patients with persistent somatising symptoms referred from general practices in Liverpool and St Helens and Knowsley were interviewed before entry into a treatment programme.Subjects 228 of 324 patients referred were interviewed. Initial interviews were used to develop the process and technique, and the final analysis was based oil a subsample of G8 records, randomly chosen fi om the transcripts of 188 subjects who were interviewed subsequently.Results Doctors' explanations were often at odds with the patients' own thinking. Analysis showed that medical explanations could be grouped into one of three categories, defined hy the patients' perceptions. Most explanations were experienced as rejecting the reality of the symptoms. An intermediate category comprised explanations that were viewed as colluding, in which the doctor acquiesced with the patients' own biomedical theories. However, a few explanations were perceived by patients as tangible, exculpating, and involving. These explanations were experienced by patients as satisfying and empowering.Conclusions Patients with somatisation disorders feel satisfied and empowered by medical explanations that are tangible, exculpating, and involving. Empowering explanations could improve these patients' wellbeing and help to reduce tbe high demands they make on health services.