Waller Göran, Hamberg Katarina, Forssén Annika
Department of Public Health and Clinical Medicine, Division of Family Medicine, Umeå University, Umeå, Sweden.
Br J Gen Pract. 2015 Sep;65(638):e624-9. doi: 10.3399/bjgp15X686557.
In epidemiological research, self-rated health is an independent predictor of mortality, cardiovascular diseases, and other critical outcomes. It is recommended for clinical use, but research is lacking.
To investigate what happens in consultations when the question 'How would you assess your general health compared with others your own age?' is posed.
Authentic consultations with GPs at health centres in Sweden.
Thirty-three planned visits concerning diabetes, pain, or undiagnosed symptoms were voice-recorded. Dialogue regarding self-rated health was transcribed verbatim and analysed using a systematic text condensation method. Speaking time of patients and doctors was measured and the doctors' assessment of the value of the question was documented in a short questionnaire.
Two overarching themes are used to describe patients' responses to the question. First, there was an immediate reaction, often expressing strong emotions, setting the tone of the dialogue and influencing the continued conversation. This was followed by reflection regarding their functional ability, management of illnesses and risks, and/or situation in life. The GPs maintained an attitude of active listening. They sometimes reported a slight increase in consultation time or feeling disturbed by the question, but mostly judged it as valuable, shedding additional light on the patients' situation and making it easier to discuss difficulties and resources. The patients' speaking time increased noticeably during this part of the consultation.
Asking patients to comparatively self-rate their health is an effective tool in general practice.
在流行病学研究中，自我评估健康状况是死亡率、心血管疾病及其他关键结果的独立预测指标。虽推荐其用于临床，但相关研究匮乏。
探究当提出“与同龄人相比，您如何评价自己的总体健康状况？”这一问题时，会诊中会发生什么。
在瑞典健康中心与全科医生进行的真实会诊。
对33次有关糖尿病、疼痛或未确诊症状的计划就诊进行录音。逐字转录关于自我评估健康状况的对话，并采用系统文本浓缩法进行分析。测量患者和医生的发言时间，并通过简短问卷记录医生对该问题价值的评估。
用两个总体主题描述患者对该问题的回答。首先，存在即时反应，常表达强烈情绪，为对话定下基调并影响后续交谈。随后是对其功能能力、疾病管理与风险及/或生活状况的思考。全科医生保持积极倾听的态度。他们有时报告会诊时间略有增加或感觉被该问题干扰，但大多认为其有价值，能进一步了解患者情况，便于讨论困难和资源。在会诊的这一部分，患者的发言时间显著增加。
在全科医疗中，让患者对自己的健康状况进行比较性自我评估是一种有效的工具。
