Serjeant Sarah, Abbott Sally, Parretti Helen, Greenfield Sheila
Coventry University, Coventry, UK
Coventry University, Coventry, UK.
BMJ Open. 2025 Apr 2;15(4):e086722. doi: 10.1136/bmjopen-2024-086722.
To use vignettes to facilitate exploration of the internal dialogue and clinical reasoning processes of general practice healthcare professionals (GPHCPs) during interactions with patients living with obesity.
This study used an exploratory qualitative research design. Data were collected using semistructured interviews. Interviews were transcribed verbatim, and data analysed using Framework Method analysis. Five vignettes were presented to participants, showing a patient's photograph, name, age and body mass index. Participants were asked to describe their first impressions of each fictionalised patient.
Interviews were conducted remotely via Skype between August and September 2019.
A convenience sample of UK GPHCPs was recruited via a targeted social media strategy, using virtual snowball sampling. 20 participants were interviewed (11 general practice nurses and 9 general practitioners).
Five themes were generated: visual assessment, assumed internal contributing factors, assumed external contributing factors, potential clinical contributing factors and potential clinical consequences. A pattern-recognition approach was identified, as GPHCPs' assumptions around patients' lifestyles, occupations and eating habits emerged as explanations for their weight, with a mixture of both objective and subjective comments.
While it is part of the diagnostic skill of a clinician to be able to form a clinical picture based on the information available, it is important to be aware of the potential for assumptions made within this process to contribute to unconscious bias/stereotyping. Healthcare professionals need to work to counteract the potential impact of internal bias on their consultations to provide fair and equitable care for people living with obesity, by exercising reflexivity within their clinical practice.
运用案例 vignettes 促进对全科医疗保健专业人员（GPHCPs）在与肥胖患者互动过程中的内部对话和临床推理过程的探索。
本研究采用探索性定性研究设计。通过半结构化访谈收集数据。访谈逐字转录，并使用框架法进行数据分析。向参与者展示了五个案例 vignettes，包括患者的照片、姓名、年龄和体重指数。要求参与者描述他们对每个虚构患者的第一印象。
2019年8月至9月通过Skype进行远程访谈。
通过有针对性的社交媒体策略，采用虚拟雪球抽样法，招募了英国GPHCPs的便利样本。共访谈了20名参与者（11名全科护士和9名全科医生）。
产生了五个主题：视觉评估、假定的内部促成因素、假定的外部促成因素、潜在的临床促成因素和潜在的临床后果。识别出一种模式识别方法，因为GPHCPs对患者生活方式、职业和饮食习惯的假设成为对其体重的解释，既有客观评论也有主观评论。
虽然临床医生能够根据现有信息形成临床印象是诊断技能的一部分，但重要的是要意识到在此过程中做出的假设可能导致无意识偏见/刻板印象。医疗保健专业人员需要努力抵消内部偏见对其咨询的潜在影响，通过在临床实践中进行反思，为肥胖患者提供公平公正的护理。
