‘No need to worry’: an exploration of general practitioners’ reassuring strategies

Abstract

BackgroundIn view of the paucity of evidence regarding effective ways of reassuring worried patients, this study explored reassuring strategies that are considered useful by general practitioners (GPs).MethodsIn a study using a qualitative observational design, we re-analysed an existing dataset of fifteen stimulated recall interviews in which GPs elaborated on their communication with patients in two videotaped consultations. Additionally we held stimulated recall interviews with twelve GPs about two consultations selected for a strong focus on reassurance.ResultsTo reassure patients, GPs pursued multiple goals: 1. influencing patients’ emotions by promoting trust, safety and comfort, which is considered to be reassuring in itself and supportive of patients’ acceptance of reassuring information and 2. influencing patients’ cognitions by challenging patients’ belief that their symptoms are indicative of serious disease, often followed by promoting patients’ belief that their symptoms are benign. GPs described several actions to activate mechanisms to achieve these goals.ConclusionsGPs described a wealth of reassuring strategies, which make a valuable contribution to the current literature on doctor-patient communication. This detailed description may provide practicing GPs with new tools and can inform future studies exploring the effectiveness of reassurance strategies.

Patients’ experiences of the use of point-of-care ultrasound in general practice – a cross-sectional study

“…GPs undertaking POCUS must be aware of this risk and communicate their medical reasoning to patients. However, providing reassurance for patients is both important and common in general practice [ 39 ] and GPs have been found to use diagnostic tests to reassure themselves and patients [ 35 , 40 ]. Measuring dimensions of reassurance immediately after the consultation, we found that patients felt an increased trust in their GP and a sense of security.…”

Communication challenges in end-of-life decisions

“…Although sometimes done with good intentions, physicians should avoid premature reassurances (e.g., "It is not that bad…", "Everything is going to be fine") [21,22]. First, if patients' emotions are not addressed adequately, premature reassurance may be perceived by patients as not respecting their worries and fears.…”

Eliciting tacit knowledge: The potential of a reflective approach to video-stimulated interviewing

“…Since evidence-based decision-making is often regarded as a normative issue, using the recordings might stop the professionals from giving socially acceptable answers instead of reflecting on their actual behaviour. In another project, we used videotaped consultations in interviews with experienced doctors to stimulate them to reflect on their reassuring behaviour [31]. The level of detail in the doctors’ reflections allowed us to uncover working mechanisms underlying the reassuring behaviour, guiding the reader to put this behaviour in context.…”

“…Rather, they view the reflective interview as an opportunity (for interviewees) to ‘review events in which they have participated from an outsiders’ perspective but with an insider’s insight into their motivations and intentions’ [32]. The focus on reflection enables participants to construct meaning to behaviours applied unconsciously in practice [31], thus making the tool especially suited to uncover tacit theories, implicit ideas, and unspoken strategies behind learning and teaching in medical education.…”

“…During the interviews, we had to assure participants repeatedly that they were not being judged, but that we were interested in their decision-making in a very complex context. In dealing with this issue, it is helpful to consider that (a) participants are more open and more likely to reflect on their emotions when interviewed by a peer, especially if that peer is less experienced [20, 33]; (b) the interviewer should not be involved in the participants’ medical/professional training; and (c) it is important to repeatedly emphasize the goal of the study and that the participant will not be assessed [31, 34].…”