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

PloS One
N M H KrommeH B M van de Wiel

Abstract

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). To explore internists' interaction strategy discourses in the context of MES and MUS. 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. 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...Continue Reading

References

Apr 22, 1992·JAMA : the Journal of the American Medical Association·E J Emanuel, L L Emanuel
Nov 1, 1995·Postgraduate Medical Journal·S Smith
Jul 1, 1996·Psychological Medicine·A E SpeckensM W Hengeveld
Dec 31, 1997·Annals of Internal Medicine·M Von KorffE H Wagner
Oct 3, 2000·Patient Education and Counseling·D Roter
Jul 11, 2001·Mayo Clinic Proceedings·D L Roter, J A Hall
Jul 13, 2001·Journal of Psychosomatic Research·C NimnuanS Wessely
Jan 31, 2002·Health Affairs·E H WagnerA Bonomi
Jun 25, 2003·Social Science & Medicine·Pia Asbring, Anna-Liisa Närvänen
Aug 14, 2003·Academic Medicine : Journal of the Association of American Medical Colleges·Suzanne KurtzJuliet Draper
Nov 25, 2003·Patient Education and Counseling·Susan MichieJohn Weinman
Apr 29, 2005·Journal of Pain and Symptom Management·Andrew N Davies, Tina Quinn
Aug 26, 2006·Medical Care·Arthur J BarskyDavid W Bates
Sep 12, 2006·European Journal of Internal Medicine·Rael D StrousMoshe Kotler
Mar 29, 2007·Annals of Family Medicine·Paul Haidet
Apr 5, 2007·Journal of General Internal Medicine·Rachel A ElliottStephen B Soumerai
Jan 15, 2008·Health Care Analysis : HCA : Journal of Health Philosophy and Policy·Eric MollemanFrans Jaspers
Dec 25, 2008·The British Journal of General Practice : the Journal of the Royal College of General Practitioners·Jan MatthysMyriam Deveugele
Jan 13, 2009·Patient Education and Counseling·Robert L Hulsman
Jan 26, 2011·Journal of General Internal Medicine·Sherri A Hinchey, Jeffrey L Jackson
Jun 16, 2011·The Journal of Ambulatory Care Management·Linda M GerberPenny H Feldman
Nov 24, 2012·Veterinary Ophthalmology·Allyson D GrothChristopher J Murphy
Jan 29, 2013·Patient Education and Counseling·Robert C SmithRichard M Frankel
Jul 1, 2014·Academic Medicine : Journal of the Association of American Medical Colleges·Bridget C O'BrienDavid A Cook
Nov 8, 2014·Health Expectations : an International Journal of Public Participation in Health Care and Health Policy·Cheryl HunterPeter Salmon
Aug 13, 2015·The New England Journal of Medicine·Lisa Rosenbaum
Sep 15, 2015·European Journal of Internal Medicine·Filomena PietrantonioMicaela La Regina
Feb 18, 2016·The New England Journal of Medicine·Suzanne Koven

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