Internists’ dilemmas in their interactions with chronically ill patients: A comparison of their interaction strategies and dilemmas in two different medical contexts
| Autor: | N.M.H. Kromme, Kees Ahaus, Harry B. M. van de Wiel, Rijnold O.B. Gans |
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| Přispěvatelé: | Research programme OPERA, Lifestyle Medicine (LM), Groningen Kidney Center (GKC), Value, Affordability and Sustainability (VALUE), Lifelong Learning, Education & Assessment Research Network (LEARN) |
| Jazyk: | angličtina |
| Rok vydání: | 2018 |
| Předmět: |
Male
Medical Doctors Discourse analysis Health Care Providers lcsh:Medicine Social Sciences ACTIVATION 0302 clinical medicine Cognition Surveys and Questionnaires Medicine and Health Sciences Contradiction Psychology 030212 general & internal medicine Medical Personnel lcsh:Science media_common Language Chronic care Multidisciplinary 030503 health policy & services Communication Middle Aged GENERAL-PRACTITIONERS Professions COMMUNICATION STRATEGIES HEALTH OUTCOMES Female UNEXPLAINED PHYSICAL SYMPTOMS Symptom Assessment 0305 other medical science Psychosocial CHRONIC ILLNESS Research Article Adult Psychotherapist Patients Distancing media_common.quotation_subject Decision Making Context (language use) Interpersonal communication DOCTORS 03 medical and health sciences Diagnostic Medicine Physicians Terminology as Topic Humans OLDER-ADULTS Health Services Needs and Demand Physician-Patient Relations Psychological and Psychosocial Issues lcsh:R Cognitive Psychology Biology and Life Sciences CARE Dilemma Health Care MODEL Medically Unexplained Symptoms Geriatrics Chronic Disease People and Places Cognitive Science lcsh:Q Population Groupings Neuroscience |
| Zdroj: | PLoS ONE, 13(5):e0194133. PUBLIC LIBRARY SCIENCE PLoS ONE PLoS ONE, Vol 13, Iss 5, p e0194133 (2018) |
| ISSN: | 1932-6203 |
| Popis: | BackgroundInternists appear to define productive interactions, key concept of the Chronic Care Model, as goal-directed, catalyzed by achieving rapport, and depending on the medical context: i.e. medically explained symptoms (MES) or medically unexplained symptoms (MUS).ObjectiveTo explore internists’ interaction strategy discourses in the context of MES and MUS.MethodsWe interviewed twenty internists working in a Dutch academic hospital, identified relevant text fragments in the interview transcripts and analyzed the data based on a discourse analysis approach.ResultsWe identified four interaction strategy discourses: relating, structuring, exploring, and influencing. Each was characterized by a dilemma: relating by ‘creating nearness versus keeping distance’; structuring by ‘giving space versus taking control’; exploring by ‘asking for physical versus psychosocial causes’; and influencing by ‘taking responsibility versus accepting a patient’s choice. The balance sought in these dilemmas depended on whether the patient’s symptoms were medically explained or unexplained (MES or MUS). Towards MUS the internists tended to maintain greater distance, take more control, ask more cautiously questions related to psychosocial causes, and take less responsibility for shared decision making.Discussion and conclusionsAdopting a basic distinction between MES and MUS, the internists in our study appeared to seek a different balance in each of four rather fundamental clinical dilemmas. Balancing these dilemmas seemed more difficult regarding MUS where the internists seemed more distancing and controlling, and tended to draw on their medical expertise. Moving in this direction is counterproductive and in contradiction to guidelines which emphasize that MUS patients warrant emotional support requiring a shift towards interpersonal, empathic communication. |
| Databáze: | OpenAIRE |
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