Dowell Anthony, Morris Caroline, Macdonald Lindsay, Stubbe Maria
Department Primary Health Care & General Practice, University of Otago, 23a Mein Street, Wellington, New Zealand.
BMC Fam Pract. 2017 Oct 18;18(1):91. doi: 10.1186/s12875-017-0662-9.
Gout is the most common form of inflammatory arthritis and is associated with considerable co-morbidity. It is usually managed in the primary care setting with a combination of lifestyle modification and pharmacological therapy. This study describes patterns of communication about gout observed in interactions between patients and primary care practitioners during routine consultations.
Secondary analysis of video-recordings of individual healthcare consultations between patients and a range of primary care practitioners (including general practitioners, practice nurses, podiatrists and dietitians) from an archived database. Consultations that included any discussion about gout were eligible for inclusion (n = 31) and were not restricted to those where gout was the main presenting complaint. The consultation transcripts were analysed using a qualitative inductive approach from clinical and linguistic perspectives and supplemented with visual observation of the interactions.
Two main themes emerged from the data; the importance of gout and 'telling' versus 'listening' in consultations. The first theme had two distinct strands; gout as an incidental part of the consultation and the impact of gout on patients. A trend towards more didactic practitioner communication encompassed by the second theme occurred at many different consultation points including diagnosis, in more general post-diagnosis discussion, and when discussing biochemical test results and lifestyle advice. In contrast, when discussion about treatment with medicines occurred a tendency towards a greater degree of listening to patients was observed.
Our observation of the communication patterns in these consultations illustrates an inherent complexity of gout consultations in primary care. Gout may be more important to patients than is often apparent to practitioners in routine consultations. Consultation management needs to take into account the impact of the condition and the balance of information provided around lifestyle advice versus long-term management with medicines.
痛风是炎症性关节炎最常见的形式，且与相当多的合并症相关。它通常在初级保健机构中通过生活方式改变和药物治疗相结合的方式进行管理。本研究描述了在常规会诊期间患者与初级保健从业者互动中观察到的痛风沟通模式。
对来自一个存档数据库的患者与一系列初级保健从业者（包括全科医生、执业护士、足病医生和营养师）之间个体医疗会诊的视频记录进行二次分析。包括任何关于痛风讨论的会诊都符合纳入标准（n = 31），且不限于以痛风为主要就诊主诉的会诊。会诊记录从临床和语言角度采用定性归纳法进行分析，并辅以对互动的视觉观察。
数据中出现了两个主要主题；痛风的重要性以及会诊中的“告知”与“倾听”。第一个主题有两个不同的方面；痛风作为会诊的附带部分以及痛风对患者的影响。第二个主题所涵盖的从业者更具说教性沟通趋势出现在许多不同的会诊点，包括诊断时、更一般的诊断后讨论中，以及讨论生化检测结果和生活方式建议时。相比之下，在讨论药物治疗时，观察到有更多倾听患者意见的倾向。
我们对这些会诊中沟通模式的观察说明了初级保健中痛风会诊的内在复杂性。痛风对患者可能比对常规会诊中的从业者更重要。会诊管理需要考虑该疾病的影响以及围绕生活方式建议与药物长期管理所提供信息的平衡。
