Department of Psychology, University of Guelph, Guelph, ON, N1G 2W1, Canada.
Department of Medicine - Division of Nephrology, 3-063 Research Transition Facility, University of Alberta, Edmonton, AB T6G 2V2, Canada.
Soc Sci Med. 2018 Jul;208:34-40. doi: 10.1016/j.socscimed.2018.04.054. Epub 2018 May 1.
Asthma is a common respiratory condition with high prevalence rates globally. While there are effective treatments, asthma remains an important health concern as people continue to die from severe attacks. Improving the experiences of, and health outcomes for, people with asthma depends heavily on their interactions with healthcare professionals. Understanding negative clinical encounters will benefit people with asthma and healthcare providers.
To examine epistemic tensions in negative clinical encounters from a patient perspective, with an aim to better understand how patients respond to these tensions. Much of the scholarship on patient interactions with healthcare providers examines interpersonal or structural factors. Thus, focusing our analysis on tensions between lay and expert knowledge in negative clinical encounters provides a novel contribution to this body of scholarship.
As part of a larger qualitative study (n = 70) examining the lived experiences of people who have asthma or a child with asthma, semi-structured interviews with 17 participants who described having negative clinical encounters were analyzed for themes.
Participants responded to epistemic tensions in two main ways: (1) by incorporating expert knowledge; and (2) by resisting/challenging expert knowledge. In both cases, participants also described feeling frustrated and uncertain about their or their child's clinical care. We analyze these responses by drawing on Lindström and Karlsson's (2016) conceptualization of epistemic tensions as arising from 3 characteristics of epistemic asymmetry: access, rights, and responsibility.
Based on this study, (1) a patient's confidence in claiming epistemic access and asserting epistemic rights when epistemic tensions arise are related to the context and their own history of living with asthma; and (2), epistemic tensions can make visible the power relations in the patient-clinician relationship, which can lead to the exertion of biomedical authority, or the taking up of patient's lay knowledge.
哮喘是一种常见的呼吸道疾病，在全球范围内发病率很高。尽管有有效的治疗方法，但由于人们仍死于严重发作，哮喘仍然是一个重要的健康问题。改善哮喘患者的体验和健康结果在很大程度上取决于他们与医疗保健专业人员的互动。了解负面的临床接触将使哮喘患者和医疗保健提供者受益。
从患者的角度探讨负面临床接触中的认识紧张，旨在更好地了解患者对这些紧张的反应。关于患者与医疗保健提供者互动的大部分学术研究都考察了人际或结构因素。因此，将我们的分析重点放在负面临床接触中基础知识与专业知识之间的紧张关系上，这是对该学术研究的一个新贡献。
作为一项更大的定性研究（n=70）的一部分，该研究检查了患有哮喘或哮喘儿童的人的生活经历，对 17 名描述有负面临床接触经历的参与者进行了半结构化访谈，以分析主题。
参与者对认识紧张有两种主要反应方式：（1）纳入专业知识；（2）抵制/挑战专业知识。在这两种情况下，参与者还描述了对自己或孩子的临床护理感到沮丧和不确定。我们通过借鉴林斯特伦和卡尔森（2016）对认识紧张的概念化，即认识紧张源于认识不对称的 3 个特征：访问权、权利和责任，来分析这些反应。
基于这项研究，（1）当出现认识紧张时，患者对主张认识访问权和认识权利的信心与其所处的环境及其自身的哮喘生活史有关；（2）认识紧张可以使医患关系中的权力关系变得明显，这可能导致生物医学权威的行使，或患者基础知识的采用。
