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Positive self-assessed general health in patients with medical problems. A qualitative study from general practice
Kirsti Malterud1, Hanne Hollnagel
1Central Research Unit and Department of General Practice, University of Copenhagen, Panum Institute, Denmark. kirsti.malterud@isf.uib.no
Background:
Patient and doctor do not always agree on the status of the patient's health. By underestimating the patient's strong sides, the doctor may be contributing to disempowerment and bypassing knowledge needed for adequate medical diagnosis and management.
Objective:
To understand how our patients with medical problems assess their general health as good.
Design And Setting:
Qualitative observational study based on audiotaped material from general practice consultations in authors' practices (Norway and Denmark). The patients were asked to rate their current state of health on a scale ranging from zero to 100, and then to explain their score.
Subjects:
From 41 consecutive consultations we compiled a purposeful sample of 12 patients who reported positive self-assessed general health although medical problems were present. The 7 women and 5 men were aged between 43 and 96 years, and had been diagnosed with musculoskeletal disorders, heart disease, cancer, depression, headache or severe menopausal symptoms.
Main Outcome Measures:
Salutogenesis, represented by the authors' Health Resource/Risk Balance Model, and Antonovsky's Sense of Coherence (SOC) concept comprised the theoretical framework. Transcripts from audiotaped consultations were used for qualitative text condensation analysis, inspired by Giorgi's phenomenological method. Analysis was theory-driven, applying comprehensibility, manageability and meaningfulness as entries to elaborate patients' accounts of positive health.
Results:
Patients' answers demonstrated how a feeling of logical reasoning related to symptom perception could provide comfort and sometimes lead to advantageous coping strategies. Personal and social resources were mentioned as essential means for tolerating and managing the burden of disease. Even fairly extensive endeavours could be experienced as worthwhile when sometimes providing relief, even only temporarily.
Conclusions:
Patients' accounts of general health can challenge the traditional medical views on assessment of health and disease.
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