Johansson E E, Hamberg K, Westman G, Lindgren G
Department of Family Medicine, Umeå University, Sweden.
Soc Sci Med. 1999 Jun;48(12):1791-802. doi: 10.1016/s0277-9536(99)00080-5.
A grounded theory study with repeated semi-structured interviews was conducted to explore the meaning of the illness experiences of women patients, impaired by biomedically undefined musculoskeletal pain. Twenty female patients were recruited at an urban primary health care centre in northern Sweden, where two of the researchers work as family physicians. In this paper we focus on considerations of patient pain and analyze the findings from aspects linking together body, gender, and society. Four categories of symptom description were identified: bodily presentations, explanatory models, consequences of pain for the patient's activities, and consequences for her self-perception. The bodily symptoms signaled loss of control. The explanatory models consisted of physical damage and strain injuries, but were also psychological and self-blaming. The consequences of pain were described as negative consequences for the women's everyday life that challenged their self-perception as women. The participants' search and need for legitimization of their illness experiences, and the expectations placed on doctors as legitimizing agents was evident. To achieve the desired shared understanding in consultations, doctors must be aware of and consider not only physical signs and symptoms, but also the patients' gendered concerns and psycho-social circumstances.
我们开展了一项基于扎根理论的研究，采用重复半结构化访谈的方式，以探究受生物医学上未明确的肌肉骨骼疼痛影响的女性患者疾病体验的意义。在瑞典北部的一个城市初级卫生保健中心招募了20名女性患者，其中两名研究人员在该中心担任家庭医生。在本文中，我们聚焦于对患者疼痛的考量，并从身体、性别和社会相互关联的方面分析研究结果。我们识别出四类症状描述：身体表现、解释模型、疼痛对患者活动的影响以及对其自我认知的影响。身体症状表明失去了控制。解释模型包括身体损伤和劳损，但也涉及心理因素和自我责备。疼痛的影响被描述为对女性日常生活产生负面影响，挑战了她们作为女性的自我认知。参与者对自身疾病体验合法化的探寻和需求，以及对医生作为合法化推动者的期望显而易见。为了在诊疗过程中达成理想的共同理解，医生不仅必须意识到并考虑身体体征和症状，还应关注患者基于性别的担忧和心理社会状况。
