McCabe Rosemarie, Heath Christian, Burns Tom, Priebe Stefan
Unit for Social and Community Psychiatry, Barts and the London School of Medicine, Newham Centre for Mental Health, London E13 8SP, UK.
BMJ. 2002 Nov 16;325(7373):1148-51. doi: 10.1136/bmj.325.7373.1148.
To investigate how doctors engage with patients with psychotic illness in routine consultations.
Conversation analysis of 32 consultations between psychiatrists and patients with schizophrenia or schizoaffective disorder.
Two psychiatric outpatient clinics in east London and south west London.
7 psychiatrists and 32 patients with schizophrenia or schizoaffective disorder.
Mutual engagement in communication during the consultation.
Patients actively attempted to talk about the content of their psychotic symptoms in consultations by asking direct questions, repeating their questions and utterances, and producing these utterances in the concluding part of the consultation. In response, doctors hesitated, responded with a question rather than with an answer, and smiled or laughed (when informal carers were present), indicating that they were reluctant to engage with patients' concerns about their psychotic symptoms.
Patients repeatedly attempted to talk about the content of their psychotic symptoms, which was a source of noticeable interactional tension and difficulty. Addressing patients' concerns about their illness may lead to a more satisfactory outcome of the consultation and improve engagement of such patients in the health services.
探讨医生在常规会诊中如何与患有精神疾病的患者进行交流。
对精神科医生与精神分裂症或分裂情感性障碍患者之间的32次会诊进行对话分析。
伦敦东部和伦敦西南部的两家精神科门诊诊所。
7名精神科医生和32名患有精神分裂症或分裂情感性障碍的患者。
会诊期间交流中的相互参与情况。
患者在会诊中通过直接提问、重复问题和话语，并在会诊结尾部分说出这些话语，积极尝试谈论其精神病症状的内容。作为回应，医生会犹豫，用一个问题而非答案来回应，并且（当有非正式护理人员在场时）微笑或大笑，这表明他们不愿回应患者对其精神病症状的担忧。
患者反复尝试谈论其精神病症状的内容，这是明显的互动紧张和困难的根源。解决患者对其疾病的担忧可能会使会诊结果更令人满意，并提高此类患者对医疗服务的参与度。
