核磁共振扫描显示完全正常":慢性肌肉骨骼疼痛患者在临床会诊中的保证尝试。

IF 1.9 4区 医学 Q3 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH
Health Pub Date : 2024-10-20 DOI:10.1177/13634593241290185
Trine Cb Andersen, Maja Wilhelmsen, Olaug S Lian
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引用次数: 0

摘要

在针对慢性肌肉骨骼疼痛患者的临床指南中,安抚是一个关键要素。安抚患者的目的是改变他们对疾病的看法,进而改变他们的行动。然而,当症状持续存在而没有病理发现时,安抚就很难实现。我们通过观察十九个自然发生的慢性肌肉骨骼疼痛患者的医院会诊,然后对患者和临床医生进行个别访谈,研究他们在安抚方面是如何互动的。我们的主要目的是探索临床医生明确尝试提供保证的方式,以及患者如何接受这些尝试,然后结合他们互动所处的社会文化背景,反思成功保证的促进和阻碍因素。通过主题分析,确定了明确安抚的四个主要因素:(1) 通过可视化进行教育;(2) 通过技术发现进行验证;(3) 通过身体检查进行验证;(4) 使疼痛正常化。为了更深入地了解安抚过程,我们对包含这些要素的对话摘录进行了叙述性探讨。分析表明,患者的经历与临床医生所依赖的生物医学知识之间可能缺乏一致性。尽管临床医生采用了情感和认知相结合的安抚方式,但他们的最终结论往往不是建立在患者的经历之上,而是建立在生物医学知识之上,而生物医学知识对他们自己来说是认识论上的首要知识。从这个意义上说,他们安抚病人的努力可能也是他们寻求自我安抚的一种方式。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
'The MRI-scan says it is completely normal': Reassurance attempts in clinical encounters among patients with chronic musculoskeletal pain.

In clinical guidelines for patients with chronic musculoskeletal pain, reassurance is a key element. The purpose of reassuring patients is to change their views on their illness and, thereby, their actions. However, when symptoms persist without pathological findings, reassurance can be difficult to achieve. Drawing on observations of nineteen naturally occurring hospital consultations with chronic musculoskeletal pain patients, followed by individual interviews with both patients and clinicians, we study how they interact in relation to reassurance. Our main aim is to explore the ways in which clinicians explicitly attempt to provide reassurance, and how patients receive these attempts, before reflecting on facilitating and hindering factors for successful reassurance in relation to the sociocultural context in which their interaction takes place. Through a thematic analysis, four dominating elements of explicit reassurance were identified: (1) education through visualisation, (2) validation through technological findings, (3) validation through physical examination and (4) normalising pain. To gain a deeper understanding of the reassurance process, we then narratively explored dialogical extracts containing these elements. The analysis shows a potential lack of congruence between what patients experience, and the biomedical knowledge clinicians rely on. Despite employing a combination of affective and cognitive modes of reassurance, clinicians tend to build their final conclusions not on patients experiences but on biomedical knowledge, which is knowledge that holds epistemic primacy for themselves. In that sense, their efforts to reassure the patients might also be a way in which they seek to reassure themselves.

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来源期刊
Health
Health Multiple-
CiteScore
4.90
自引率
0.00%
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0
期刊介绍: Health: is published four times per year and attempts in each number to offer a mix of articles that inform or that provoke debate. The readership of the journal is wide and drawn from different disciplines and from workers both inside and outside the health care professions. Widely abstracted, Health: ensures authors an extensive and informed readership for their work. It also seeks to offer authors as short a delay as possible between submission and publication. Most articles are reviewed within 4-6 weeks of submission and those accepted are published within a year of that decision.
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