Lian Olaug S, Robson Catherine
a Department of Community Medicine, Faculty of health sciences , University of Tromsø - The Arctic University of Norway , Tromsø , Norway.
Int J Qual Stud Health Well-being. 2017;12(sup2):1392219. doi: 10.1080/17482631.2017.1392219.
Clinical encounters related to medically unexplained physical symptoms (MUPS) are associated with high levels of conflict between patients and doctors. Collaborative difficulties are fused by the medical uncertainty that dominates these consultations. The main aim of this study is to explore the interactional dynamics of clinical encounters riddled by medical uncertainty, as experienced by people living with long-term medically unexplained fatigue in Norway.
A qualitative thematic analysis of written texts from 256 study participants.
We found that patients experience being met with disbelief, inappropriate psychological explanations, marginalisation of experiences, disrespectful treatment, lack of physical examination and damaging health advice. The main source of their discontent is not the lack of biomedical knowledge, but doctors who fail to communicate acknowledgement of patients' experiences, knowledge and autonomy. War metaphors are emblematic of how participants describe their medical encounters. The overarching storyline depicts experiences of being caught in a power struggle with doctors and health systems, fused by a lack of common conceptual ground.
When physical symptoms cannot be detected, explained and managed by biomedical knowledge and technology, good doctor-patient partnerships are crucial. Without clearly acknowledging patients' perspectives and capabilities in clinical practice, such partnerships cannot be achieved.
与医学上无法解释的身体症状（MUPS）相关的临床接触会导致患者与医生之间产生高度冲突。协作困难因主导这些会诊的医学不确定性而加剧。本研究的主要目的是探讨挪威长期患有医学上无法解释的疲劳的人所经历的、充满医学不确定性的临床接触中的互动动态。
对256名研究参与者的书面文本进行定性主题分析。
我们发现患者感到自己遭遇了怀疑、不恰当的心理学解释、经历被边缘化、受到不尊重的对待、缺乏身体检查以及有害的健康建议。他们不满的主要根源并非缺乏生物医学知识，而是医生未能表达对患者经历、知识和自主权的认可。战争隐喻是参与者描述其医疗接触的典型方式。总体故事情节描绘了陷入与医生及医疗系统权力斗争的经历，这种斗争因缺乏共同概念基础而加剧。
当生物医学知识和技术无法检测、解释和处理身体症状时，良好的医患伙伴关系至关重要。在临床实践中若不明确认可患者的观点和能力，就无法实现这种伙伴关系。
