Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK.
Department of Computer Science, Human Centred Computing, University of Oxford, Oxford, UK.
Patient Educ Couns. 2022 Mar;105(3):524-533. doi: 10.1016/j.pec.2021.08.017. Epub 2021 Aug 25.
Guidelines recommend that clinicians should offer patients with obesity referrals to weight management services. However, clinicians and patients worry that such conversations will generate friction, and the risk of this is greatest when patients say no. We examined how doctors actually respond to patient refusals, and how patients reacted to clinicians in turn.
Conversation analysis of 226 GP-patient interactions recorded during a clinical trial of weight management referrals in UK primary care.
Some clinicians responded to refusals by delivering further information or offering referral again. These actions treated patient refusals as unwelcome, and acted to pursue acceptance instead. However, pursuit did not lead to acceptance. Rather, pursuing acceptance lengthened consultations and led to frustration, offence, or anger. Clinicians who accepted refusals and closed the consultation avoided friction and negative emotional displays.
Patient refusals have the potential to create negative consequences in the consultation and clinician responses were key in avoiding these. When clinicians acknowledged the legitimacy of patient refusals, negative consequences were avoided, and the conversation was briefer and smoother.
When patients refuse the offer of a free weight management referral, GPs should accept this refusal, rather than trying to persuade patients to accept.
指南建议临床医生应为肥胖患者提供转至体重管理服务的建议。然而，临床医生和患者担心此类对话会产生摩擦，而当患者拒绝时，这种风险最大。我们研究了医生实际上如何回应患者的拒绝，以及患者反过来如何对临床医生做出反应。
对英国初级保健中体重管理转介临床试验期间记录的 226 次全科医生-患者互动进行会话分析。
一些临床医生通过提供更多信息或再次提供转介来回应拒绝。这些行为将患者的拒绝视为不受欢迎，并试图追求接受。然而，追求并没有导致接受。相反，追求接受会延长咨询时间，并导致沮丧、冒犯或愤怒。接受拒绝并结束咨询的临床医生避免了摩擦和负面情绪的表现。
患者的拒绝有可能在咨询中产生负面后果，而临床医生的反应是避免这些后果的关键。当临床医生承认患者拒绝的合理性时，就可以避免负面后果，并且对话会更简短、更顺畅。
当患者拒绝接受免费的体重管理转介时，全科医生应该接受这种拒绝，而不是试图说服患者接受。
