Epstein Laura, Ogden Jane
Limehouse General Practice, London.
Br J Gen Pract. 2005 Oct;55(519):750-4.
Due to the increased prevalence of obesity GPs now have a key role in managing obese patients.
To explore GPs' views about treating patients with obesity.
An inner London primary care trust.
A qualitative study using semi-structured interviews.
Twenty-one GPs working in an inner London primary care trust were interviewed about recent obese patients and obesity in general. An interpretative phenomenological approach was used for data analysis.
GPs primarily believed that obesity was the responsibility of the patient, rather than a medical problem requiring a medical solution. They also believed that in contrast to this, obese patients wanted to hand responsibility over to their doctor. This contradiction created conflict for the GPs, which was exacerbated by a sense that existing treatment options were ineffective. Further, this conflict was perceived as potentially detrimental to the doctor-patient relationship. GPs described a range of strategies that they used to maintain a good relationship including offering anti-obesity drugs, in which they had little faith, as a means of meeting patients' expectations; listening to the patients' problems, despite not having a solution to them; and offering an understanding of the problems associated with being overweight.
GPs believe that although patients want them to take responsibility for their weight problems, obesity is not within the GP's professional domain. Until more effective interventions have been developed GPs may remain unconvinced that obesity is a problem requiring their clinical expertise and may continue to resist any government pressure to accept obesity as part of their workload.
由于肥胖症患病率上升,全科医生在管理肥胖患者方面如今发挥着关键作用。
探讨全科医生对治疗肥胖患者的看法。
伦敦市中心的一个初级医疗信托机构。
采用半结构式访谈的定性研究。
对在伦敦市中心一个初级医疗信托机构工作的21名全科医生进行访谈,内容涉及近期的肥胖患者及肥胖症总体情况。数据分析采用解释现象学方法。
全科医生主要认为肥胖是患者自身的责任,而非需要医学解决办法的医学问题。他们还认为,与此相反,肥胖患者希望将责任交给医生。这种矛盾给全科医生带来了冲突,而现有的治疗选择无效这一感觉又加剧了这种冲突。此外,这种冲突被认为可能对医患关系有害。全科医生描述了一系列他们用来维持良好关系的策略,包括提供他们并不看好的抗肥胖药物,以此满足患者的期望;倾听患者的问题,尽管对此没有解决办法;以及表示理解与超重相关的问题。
全科医生认为,尽管患者希望他们对体重问题负责,但肥胖并不在全科医生的专业范围内。在开发出更有效的干预措施之前,全科医生可能仍不相信肥胖是一个需要他们临床专业知识解决的问题,可能会继续抵制政府要求将肥胖纳入其工作量的任何压力。