BMJ 2000;320:541-544 ( 26 February )

Papers

Qualitative study of interpretation of reassurance among patients attending rheumatology clinics: "just a touch of arthritis, doctor?"

Jenny L Donovan, reader in social medicine, ^a David R Blake, professor of bone and joint medicine. ^b

^a Department of Social Medicine, University of Bristol, Bristol BS8 2PR, ^b Royal National Hospital for Rheumatic Diseases, Bath BA1 1RL

Correspondence to: J L Donovan jenny.donovan{at}bris.ac.uk

Objectives: To examine commonly used methods of reassurance by clinicians and explore their effect on patients.
Design: Qualitative study of tape recordings of in-depth, semistructured interviews with patients before and after consultation and of their consultations with doctors.
Setting: NHS specialist rheumatology clinics in two large British cities.
Participants: 35 patients selected by consultant rheumatologists from general practitioner referral letters (28 women, 7 men; 24 with inflammatory arthropathies, 11 other rheumatological complaints).
Main outcome measures: Patients' perceptions of reassurance.
Results: Reassurance was an important part of consultations, whether the diagnosis was clear or uncertain. Clinicians tried to reduce anxiety by emphasising the mildness, early stage, or non-seriousness of the disorder and the likelihood that patients would recover. Patients interpreted reassurance in the context of their own views and perceptions. Doctors' emphasis on the mildness or earliness of the condition raised the spectre of future pain and disability rather than providing reassurance. Patients who felt that their problems were properly acknowledged felt more reassured.
Conclusions: Typical patterns of reassurance were not successful because of the differences in perspective of patients and doctors. A key to successful reassurance seemed to be the doctor's ability to acknowledge patients' perspectives of their difficulties.

---

© BMJ 2000
CiteULike    Complore    Connotea    Del.icio.us    Digg    Reddit    StumbleUpon    Technorati    What's this?

Relevant Articles

Patients in rheumatology clinics need reassurance

Eleanor Grogan, Andrew Frank, and Andrew Keat
BMJ 2000 321: 300. [Extract] [Full Text]

Management and preferences
BMJ 2000 320: 0. [Full Text] [PDF]

Management and preferences
BMJ 2000 320: 0. [Full Text] [PDF]

Doctors' reassurances are often ineffective
BMJ 2000 320: 0. [Full Text]

Advances in managing chronic disease

Ronald M Davis, Edward G Wagner, and Trish Groves
BMJ 2000 320: 525-526. [Extract] [Full Text] [PDF]

This article has been cited by other articles:

• Howerton, A., Byng, R., Campbell, J., Hess, D., Owens, C., Aitken, P. (2007). Understanding help seeking behaviour among male offenders: qualitative interview study. BMJ 334: 303-303 [Abstract] [Full text]  
• Lempp, H., Scott, D. L., Kingsley, G. H. (2006). Patients' views on the quality of health care for rheumatoid arthritis. Rheumatology (Oxford) 45: 1522-1528 [Abstract] [Full text]  
• Lienard, A, Merckaert, I, Libert, Y, Delvaux, N, Marchal, S, Boniver, J, Etienne, A-M, Klastersky, J, Reynaert, C, Scalliet, P, Slachmuylder, J-L, Razavi, D (2006). Factors that influence cancer patients' anxiety following a medical consultation: impact of a communication skills training programme for physicians. Ann Oncol 17: 1450-1458 [Abstract] [Full text]  
• Lempp, H., Scott, D., Kingsley, G. (2006). The personal impact of rheumatoid arthritis on patients' identity: a qualitative study. Chronic Illness 2: 109-120 [Abstract]  
• Mackie, S L, Frank, A O (2003). Medically unexplained symptoms: (Letter 1 of 2). JRSM 96: 422-422 [Full text]  
• Ryan, S., Hassell, A., Dawes, P., Kendall, S. (2003). Control perceptions in patients with rheumatoid arthritis: the impact of the medical consultation. Rheumatology (Oxford) 42: 135-140 [Abstract] [Full text]  
• Steiner, W. A, Ryser, L., Huber, E., Uebelhart, D., Aeschlimann, A., Stucki, G. (2002). Use of the ICF Model as a Clinical Problem-Solving Tool in Physical Therapy and Rehabilitation Medicine. ptjournal 82: 1098-1107 [Abstract] [Full text]  
• Donovan, J., Mills, N., Smith, M., Brindle, L., Jacoby, A., Peters, T., Frankel, S., Neal, D., Hamdy, F., Little, P. (2002). Quality improvement report: Improving design and conduct of randomised trials by embedding them in qualitative research: ProtecT (prostate testing for cancer and treatment) study * Commentary: presenting unbiased information to patients can be difficult. BMJ 325: 766-770 [Abstract] [Full text]  
• Cooper, V., Hassell, A. (2002). Teaching consultation skills in higher specialist training: experience of a workshop for specialist registrars in rheumatology. Rheumatology (Oxford) 41: 1168-1171 [Abstract] [Full text]  
• Pope, C, van Royen, P, Baker, R (2002). Qualitative methods in research on healthcare quality. Qual Saf Health Care 11: 148-152 [Abstract] [Full text]  
• Madland, G, Feinmann, C (2001). NOSOLOGICAL ENTITIES?: Chronic facial pain: a multidisciplinary problem. J. Neurol. Neurosurg. Psychiatry 71: 716-719 [Abstract] [Full text]  
• Brown, C., Lloyd, K. (2001). Qualitative methods in psychiatric research. Adv. Psychiatr. Treat. 7: 350-356 [Full text]  
• Howlett, D., Rushforth, A., Stevens, D. (2000). Parents do not always understand things doctors might say to them. BMJ 321: 1160b-1160 [Full text]  
• (2000). Robin Goodfellow. Rheumatology (Oxford) 39: 1306-1306 [Full text]  
• Grogan, E., Frank, A., Keat, A. (2000). Patients in rheumatology clinics need reassurance. BMJ 321: 300-300 [Full text]  
• Hunskaar, S. (2000). Fluctuations in lower urinary tract symptoms in women. BMJ 320: 1418-1419 [Full text]  
• Penson, R. T., Seiden, M. V., Shannon, K. M., Lubratovich, M. L., Roche, M., Chabner, B. A., Lynch, T. J. Jr. (2000). Communicating Genetic Risk: Pros, Cons, and Counsel. The Oncologist 5: 152-161 [Abstract] [Full text]  
• Davis, R. M, Wagner, E. G, Groves, T. (2000). Advances in managing chronic disease. BMJ 320: 525-526 [Full text]  

Rapid Responses:

Read all Rapid Responses

Problems with reassurance

D Venugopal
bmj.com, 10 Mar 2000 [Full text]

Reassurance in rheumatology clinics

Andrew Frank
bmj.com, 17 Mar 2000 [Full text]

Online poll

Find out more on doc2doc >>