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PLoS One. 2018 May 30;13(5):e0194133. doi: 10.1371/journal.pone.0194133. eCollection 2018.

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

Author information

1
University of Groningen, University Medical Center Groningen, SectorA Chronic and Vascular Disease, Groningen, The Netherlands.
2
University of Groningen, Faculty of Economics and Business, Centre of Expertise Healthwise, Groningen, The Netherlands.
3
University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
4
University of Groningen, University Medical Center Groningen, Department of Internal Medicine, Groningen, The Netherlands.
5
University of Groningen, University Medical Center Groningen, Wenckebach Institute, Groningen, The Netherlands.

Abstract

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.

PMID:
29847552
PMCID:
PMC5976145
DOI:
10.1371/journal.pone.0194133
[Indexed for MEDLINE]
Free PMC Article

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