Publication

Internists’ dilemmas in their interactions with chronically ill patients: A comparison of their interaction strategies and dilemmas in two different medical contexts

Kromme, N. M. H., Ahaus, K. T. B., Gans, R. O. B. & van de Wiel, H. B. M., 30-May-2018, In : PLoS ONE. 13, 5, e0194133.

Research output: Contribution to journalArticleAcademicpeer-review

Copy link to clipboard

Documents

DOI

Background
Internists 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).

Objective
To explore internists’ interaction strategy discourses in the context of MES and MUS.

Methods
We 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.

Results
We 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 conclusions
Adopting 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.
Original languageEnglish
Article numbere0194133
JournalPLoS ONE
Volume13
Issue number5
Publication statusPublished - 30-May-2018

    Keywords

  • UNEXPLAINED PHYSICAL SYMPTOMS, CHRONIC ILLNESS, COMMUNICATION STRATEGIES, HEALTH OUTCOMES, GENERAL-PRACTITIONERS, OLDER-ADULTS, CARE, DOCTORS, MODEL, ACTIVATION

View graph of relations

Download statistics

No data available

ID: 61271296