Doctors expressions of uncertainty and patient confidence

Ogden, Jane; Fuks, Kaz; Gardner, Mary; Johnson, Steve; McLean, Malcolm; Martin, Pam; Shah, Reena

doi:10.1016/s0738-3991(02)00020-4

Cited by 101 publications

(119 citation statements)

References 9 publications

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“…In addition, GPs also showed a more positive belief about the role of the GP and a support group in managing obesity. Previous illustrates indicates that GPs and patients hold different beliefs concerning a number of health related issues including depression, the meaning of health, patient centredness and the expression of uncertainty (23)(24)(25)(26). The present study illustrates that they also hold different beliefs about the causes and solutions to obesity.…”

Section: Predicting Beliefs About Solutions: the Role Of Causal Beliefsmentioning

confidence: 54%

“…Tuckett et al (22) likewise argued that the consultation should be conceptualised as a 'meeting between experts' and emphasised the importance of the patients' and doctors' potentially different views of the problem. Some research has explored the degree of agreement between doctors and patients in terms of beliefs about depression, the expression of uncertainty, beliefs about patient centredness and the meaning of health (23)(24)(25)(26). Furthermore, Ogden et al (27) reported differences between doctors' and patients' beliefs about obesity and suggested that these differences may contribute to the poor rates of success of obesity management.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Beliefs about the causes and solutions to obesity: A comparison of GPs and lay people

Ogden

Flanagan

2008

Patient Education and Counseling

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107

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Section: Predicting Beliefs About Solutions: the Role Of Causal Beliefsmentioning

confidence: 54%

Section: Introductionmentioning

confidence: 99%

Beliefs about the causes and solutions to obesity: A comparison of GPs and lay people

Ogden

Flanagan

2008

Patient Education and Counseling

Self Cite

107

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“…When their ability to identify, explain and treat patients’ ailments is constrained by an uncertain biomedical foundation, they often feel powerless, inadequate, dissatisfied, frustrated and anxious (Åsbring & Närvänen, 2003; Chew-Graham, Cahill, Dowrick, Wearden, & Peters, 2008; Chew-Graham, Dowrick, Wearden, Richardson, & Peters, 2010; Howman, Walters, Rosenthal, Ajjawi, & Buszewicz, 2016; Libert et al, 2016; Murray, Toussaint, Althaus, & Löwe, 2016). For patients, experiences of uncertainty can increase psychological distress, intensify sensitivity to pain (Rosendal et al, 2013; Taylor, Marshall, Mann, & Goldberg, 2012; Weiland et al, 2012; Wright, Afari, & Zautra, 2009), and result in poorer health (Neville, 2003), reduced quality of life and diminished confidence (Ogden et al, 2002). …”

Section: Introductionmentioning

confidence: 99%

“It´s incredible how much I´ve had to fight.” Negotiating medical uncertainty in clinical encounters

Lian

Robson

2017

International Journal of Qualitative Studies on Health and Well

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Purpose: Clinical encounters related to medically unexplained physical symptoms (MUPS) are associated with high levels of conflict between patients and doctors. Collaborative difficulties are fused by the medical uncertainty that dominates these consultations. The main aim of this study is to explore the interactional dynamics of clinical encounters riddled by medical uncertainty, as experienced by people living with long-term medically unexplained fatigue in Norway. Method: A qualitative thematic analysis of written texts from 256 study participants. Results: We found that patients experience being met with disbelief, inappropriate psychological explanations, marginalisation of experiences, disrespectful treatment, lack of physical examination and damaging health advice. The main source of their discontent is not the lack of biomedical knowledge, but doctors who fail to communicate acknowledgement of patients’ experiences, knowledge and autonomy. War metaphors are emblematic of how participants describe their medical encounters. The overarching storyline depicts experiences of being caught in a power struggle with doctors and health systems, fused by a lack of common conceptual ground. Conclusion: When physical symptoms cannot be detected, explained and managed by biomedical knowledge and technology, good doctor-patient partnerships are crucial. Without clearly acknowledging patients’ perspectives and capabilities in clinical practice, such partnerships cannot be achieved.

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“…Although uncommon, physicians' expressions of uncertainty ("I don't know...") were not associated with lower patient ratings of the physician, in contrast to survey and vignette studies which suggest otherwise. 51,52 Concern has been raised about the inappropriate use of reassurance without adequate biomedical explanations or lack of empathic responses when patients present with MUS. 5,6 However, even accounting for the increased number of prompts in the MUS role, we found that physicians used empathy at least as frequently in the MUS role compared with the more straightforward GERD presentation, did not attempt to reassure more often, explored psychosocial domains, and admitted uncertainty more often.…”

Section: Discussionmentioning

confidence: 99%

“Could this Be Something Serious?”

et al. 2007

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BACKGROUND: Previous work suggests that exploration and validation of patients' concerns is associated with greater patient trust, lower health care costs, improved counseling, and more guideline-concordant care. OBJECTIVE:To describe physicians' responses to patients' worries, how their responses varied according to clinical context (straightforward versus medically unexplained symptoms [MUS]) and associations between their responses and patients' ratings of interpersonal aspects of care.DESIGN: Multimethod study. For each physician, we surveyed 50 current patients and covertly audiorecorded 2 unannounced standardized patient (SP) visits. SPs expressed worry about "something serious" in 2 scenarios: straightforward gastroesophageal reflux or poorly characterized chest pain with MUS. PARTICIPANTS:One hundred primary care physicians and 4,746 patients. MEASUREMENTS:Patient surveys measuring interpersonal aspects of care (trust, physician knowledge of the patient, satisfaction, and patient activation). Qualitative coding of 189 transcripts followed by descriptive, multivariate, and lag-sequential analyses. RESULTS:Physicians offered a mean of 3.1 responses to each of 613 SP prompts. Biomedical inquiry and explanations, action, nonspecific acknowledgment, and reassurance were common, whereas empathy, expressions of uncertainty, and exploration of psychosocial factors and emotions were uncommon. Empathy expressed during SP visits was associated with higher patient ratings of interpersonal aspects of care. After adjusting for demographics and comorbidities, the association was only statistically significant for the MUS role. Empathy was most likely to occur if expressed at the beginning of the conversational sequence.CONCLUSIONS: Empathy is associated with higher patient ratings of interpersonal care, especially when expressed in situations involving ambiguity. Empathy should be expressed early after patient expressions of worry.

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Doctors expressions of uncertainty and patient confidence

Cited by 101 publications

References 9 publications

Beliefs about the causes and solutions to obesity: A comparison of GPs and lay people

Beliefs about the causes and solutions to obesity: A comparison of GPs and lay people

“It´s incredible how much I´ve had to fight.” Negotiating medical uncertainty in clinical encounters

“Could this Be Something Serious?”

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