Lagerløv P, Leseth A, Matheson I
Department of Pharmacotherapeutics, University of Oslo, Norway.
Soc Sci Med. 1998 Jul;47(1):85-91. doi: 10.1016/s0277-9536(98)00018-5.
General practitioners (GP) differ in views on how to relate to their patients, diagnose asthma and update their knowledge. By understanding the doctors' attitudes within these domains it is possible to design a better information strategy and improve disease management. In order to get insight in the doctors' experiences and ways of thinking regarding asthma, 20 GPs were interviewed. A phenomenographic analysis was applied in describing the doctors' opinions. The doctors' opinions about who was in charge of the asthma management defined four doctor-patient relationships: I will manage it, you will manage it, we will manage it and I do not know whether I will manage it. The GPs differed markedly in how much they trusted the patients' descriptions and the physiological measurements of the disease. Three opinions on how to acquire knowledge were described. Knowledge should be acquired either from experts or from peers. Another belief did not give weight to a defined source but expressed the necessity of using all opportunities at hand. Doctors holding this belief, "the bricoleurs", seemed to be more interested in a "how to do it" than a "why to do it" information. We conclude that strategies for improving asthma management should consider the importance of both patients' accounts and physiological measures, the degree of co-operation between doctors and their patients and eventually the ways and styles of acquiring new knowledge about asthma.
全科医生（GP）在如何与患者建立联系、诊断哮喘以及更新知识方面存在不同观点。通过了解医生在这些领域的态度，有可能设计出更好的信息策略并改善疾病管理。为了深入了解医生对哮喘的经验和思维方式，对20名全科医生进行了访谈。采用现象学分析来描述医生的观点。医生们对谁负责哮喘管理的看法定义了四种医患关系：我来管理、你来管理、我们共同管理以及我不知道是否由我来管理。全科医生在信任患者对疾病的描述和生理测量结果的程度上存在显著差异。描述了关于如何获取知识的三种观点。知识应该从专家或同行那里获取。另一种观点不看重特定的知识来源，而是强调利用手头所有机会的必要性。持有这种信念的医生，即“修补匠”，似乎对“如何做”的信息比“为何做”的信息更感兴趣。我们得出结论，改善哮喘管理的策略应考虑患者陈述和生理测量的重要性、医生与患者之间的合作程度以及最终获取哮喘新知识的方式和风格。
