Qualitative study of interpretation of reassurance among patients attending rheumatology clinics: "just a touch of arthritis, doctor?"

Abstract

Objectives To examine commonly used methods of reassurance by clinicians and explore their effect on patients. Design Qualitative study of tape recordings of in-depth, semistructured interviews with patients before and after consultation and of their consultations with doctors. Setting NHS specialist rheumatology clinics in two large British cities. Participants 35 patients selected by consultant rheumatologists from general practitioner referral letters (28 women, 7 men; 24 with inflammatory arthropathies, 11 other rheumatological complaints). Main outcome measures Patients' perceptions of reassurance.Results Reassurance was an important part of consultations, whether the diagnosis was clear or uncertain. Clinicians tried to reduce anxiety by emphasising the mildness, early stage, or non-seriousness of the disorder and the likelihood that patients would recover. Patients interpreted reassurance in the context of their own views and perceptions. Doctors' emphasis on the mildness or earliness of the condition raised the spectre of future pain and disability rather than providing reassurance. Patients who felt that their problems were properly acknowledged felt more reassured. Conclusions Typical patterns of reassurance were not successful because of the differences in perspective of patients and doctors. A key to successful reassurance seemed to be the doctor's ability to acknowledge patients' perspectives of their difficulties.

A multi-centre study of interactional style in nurse specialist- and physician-led Rheumatology clinics in the UK

“…Patients and practitioners often have different perspectives on a clinical encounter, with understanding and acknowledgement of their current difficulties central to patients' perception of practitioner skill [16]. Patient perceptions are an important facet of clinical outcome but may not reflect all significant features of the delivery of care.…”

“…This is supported by Donovan and Blake [16] who report that "it was the perception of having symptoms and problems acknowledged that seemed to matter, not time itself" [p. 544].Previous qualitative research with Rheumatology outpatients [35] also confirm our interview findings that access to practitioners is important to patients (particularly between scheduled appointments as a way of gaining reassurance and coping with apprehension) and that they want to be "communicated to clearly and effectively and value positive relationships with practitioners" [p.216].…”

Attitudes of women with chronic pelvic pain to the gynaecological consultation: a qualitative study

“…Clearly, the quality of the relationship with the doctor can influence reassurance. 17 This study has addressed several of the methodological issues arising in other studies: participants are well described, purposive sampling was used, two researchers conducted the data gathering and analysis, and there was iterative development of data gathering methods. However, there remain several potential limitations.…”

Reassurance and the anxious cancer patient

“…The findings do suggest that all reassurance is not the same, but also that reassurance should be considered a specific intervention, with potential benefits, but risks for some groups of patients. It has also been suggested that reassurance should be carefully timed, and particularly that an awareness of a patient's specific concerns is helpful in providing effective reassurance (Donovan and Blake, 2000;Price, 2000;Starcevic, 2001). Spontaneous reassurance was given before patients had expressed any concerns, and therefore might be expected to be problematic.…”