Vilhelmsson Andreas, Svensson Tommy, Meeuwisse Anna
Nordic School of Public Health, Gothenburg, Sweden.
PLoS One. 2013 Jun 18;8(6):e66338. doi: 10.1371/journal.pone.0066338. Print 2013.
Starting in the 1960s, a broad-based patients' rights movement began to question doctors' paternalism and to demand disclosure of medical information, informed consent, and active participation by the individual in personal health care. According to scholars, these changes contributed to downplay the biomedical approach in favor of a more patient-oriented perspective. The Swedish non-profit organization Consumer Association for Medicines and Health (KILEN) has offered the possibility for consumers to report their perceptions and experiences from their use of medicines in order to strengthen consumer rights within the health care sector.
In this paper, qualitative content analysis was used to analyze 181 KILEN consumer reports of adverse events from antidepressant medications in order to explore patients' views of mental ill health symptoms and the doctor-patient interaction.
Overall, the KILEN stories contained negative experiences of the patients' medical encounters. Some reports indicated intense emotional outrage and strong feelings of abuse by the health care system. Many reports suggested that doctors and patients had very different accounts of the nature of the problems for which the patient was seeking help. Although patients sought help for problems like tiredness and sleeplessness (often with a personal crisis of some sort as a described cause), the treating doctor in most cases was exceptionally quick in both diagnosing depression and prescribing antidepressant treatment. When patients felt they were not being listened to, trust in the doctor was compromised. This was evident in the cases when the doctor tried to convince them to take part in medical treatment, sometimes by threatening to withdraw their sick-listing.
Overall, this study suggests that the dynamics happening in the medical encounter may still be highly affected by a medical dominance, instead of a patient-oriented perspective. This may contribute to a questionable medicalization and/or pharmaceuticalization of depression.
从20世纪60年代开始，一场广泛的患者权利运动兴起，质疑医生的家长式作风，并要求披露医疗信息、知情同意以及个人积极参与个人医疗保健。据学者称，这些变化促使人们淡化生物医学方法，转而支持更以患者为导向的观点。瑞典非营利组织药品与健康消费者协会（KILEN）为消费者提供了报告其用药感受和经历的机会，以加强医疗保健领域的消费者权利。
本文采用定性内容分析法，分析了KILEN的181份抗抑郁药物不良事件消费者报告，以探讨患者对心理健康症状以及医患互动的看法。
总体而言，KILEN的故事包含了患者医疗遭遇的负面经历。一些报告显示出强烈的情绪愤怒以及对医疗保健系统的强烈受虐感。许多报告表明，医生和患者对患者寻求帮助的问题本质有着截然不同的描述。尽管患者因疲劳和失眠等问题寻求帮助（通常将某种个人危机描述为原因），但在大多数情况下，主治医生在诊断抑郁症和开抗抑郁药治疗方面异常迅速。当患者觉得自己未被倾听时，对医生的信任就会受到损害。当医生试图说服他们接受治疗，有时甚至以撤销病假条相威胁时，这种情况就很明显。
总体而言，本研究表明，医疗遭遇中发生的动态情况可能仍受医疗主导的高度影响，而非以患者为导向的观点。这可能导致抑郁症存在可疑的医学化和/或药物化现象。
