Department of Population Health/Te Tari Hauora Taupori, University of Otago/Te Whare Wānanga o Otāgo ki Ōtautahi, Christchurch, New Zealand.
Department of Primary Health Care and General Practice, Te Tari Hauora Mātāmua me te Mātauranga Rata Whānau, University of Otago, Wellington, Wellington, New Zealand.
Health Soc Care Community. 2021 Sep;29(5):e153-e162. doi: 10.1111/hsc.13259. Epub 2021 Jan 4.
The objective of this qualitative study in New Zealand was to investigate how general practitioners and patients discuss chronic pain in consultations. Chronic pain is a complex condition that defies many commonsense understandings. It is challenging to manage and patients can come to conclude that there is an empathy deficit. To our knowledge most, if not all, studies on this topic have recruited participants whose main presenting complaint is chronic pain. Forms of chronic pain are relatively common in the population and we thought it likely that at least some discussions may be rendered invisible via these recruiting practices. The study analysed data from the Applied Research on Communication in Health repository of audio transcripts and video-recorded consultations collected from a range of studies on a variety of topics, none of which were about chronic pain specifically. We searched the 256 transcripts looking for key words that might indicate that pain was at least part of the consultation. This yielded a large number of potentially relevant transcripts. These transcripts were assessed and reduced to 18 by excluding those that were about non-physical pain or pain that was expected to resolve relatively quickly. A medical specialist in chronic pain reviewed the resulting 18 and excluded two further transcripts giving us a final sample of 16. We conducted in-depth analysis of these consultations. Rather than confirming an empathy deficit, we found a much more complex deployment of empathy in the space where the two complex systems of chronic pain and general practice meet. These findings highlight the utility of analysing data originally generated for other purposes, with permission, and in a practical sense, highlight the importance of understanding empathy as highly contextual in 'real world' practice.
本新西兰定性研究旨在探讨全科医生和患者在就诊时如何讨论慢性疼痛。慢性疼痛是一种复杂的病症，有悖于许多常识性理解。这种病难以治疗，患者可能会得出同理心缺失的结论。据我们所知，大多数（如果不是全部）关于这个主题的研究都招募了主要抱怨是慢性疼痛的参与者。慢性疼痛的形式在人群中较为常见，我们认为，至少某些讨论可能会因为这些招募做法而变得不可见。该研究分析了来自不同主题的各种研究中收集的音频抄本和视频记录咨询的应用研究在健康沟通知识库中的数据，这些研究都没有专门针对慢性疼痛。我们在 256 份抄本中搜索了可能表明疼痛至少是咨询一部分的关键词。这产生了大量潜在相关的抄本。评估这些抄本并排除那些与非身体疼痛或预计会很快缓解的疼痛无关的抄本，将其数量减少到 18 份。一位慢性疼痛医学专家审查了由此产生的 18 份抄本，并排除了另外两份，为我们提供了最终的 16 份样本。我们对这些咨询进行了深入分析。我们发现，在慢性疼痛和全科医疗这两个复杂系统相遇的空间中，同理心的运用要复杂得多，而不是证实同理心缺失。这些发现突出了分析原始为其他目的生成的数据的效用，经许可，并且在实际意义上，突出了在“现实世界”实践中理解同理心具有高度语境性的重要性。
