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Performing stable angina pectoris: an ethnographic study.

Claire Somerville1, Katie Featherstone, Harry Hemingway

  • 1Queen Mary University of London, London, UK. c.somerville@qmul.ac.uk

Social Science & Medicine (1982)
|February 2, 2008
PubMed
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Doctors often reshape patient symptom narratives to fit diagnostic criteria, potentially overlooking crucial details. This can impact accurate diagnosis and treatment, especially for conditions like angina and non-cardiac chest pain.

Area of Science:

  • Medical Sociology
  • Clinical Communication
  • Diagnostic Reasoning

Background:

  • Symptom interpretation is vital for medical diagnoses, yet its process remains unclear.
  • A significant number of patients with "non-cardiac" chest pain are later diagnosed with heart attacks, highlighting diagnostic challenges.

Purpose of the Study:

  • To investigate how patients present symptom accounts during doctor consultations.
  • To explore how doctors manage ambiguity within patient symptom narratives.
  • To understand the process of diagnostic decision-making by doctors.

Main Methods:

  • Ethnographic study observing 59 consultations of new-onset chest pain patients in a UK hospital.
  • Focus on specialist ambulatory care referrals for expert opinion.

Related Experiment Videos

Main Results:

  • Doctors frequently restructured patient narratives to align with diagnostic canons, often disregarding patient interpretations.
  • Patients sometimes resisted this restructuring, particularly regarding concepts like exertion.
  • Symptom narratives proved unstable, and translation needs for South Asian patients sometimes led to histories being deemed less relevant.

Conclusions:

  • The current diagnostic approach may oversimplify complex patient symptom descriptions.
  • Further research into the diagnostic and prognostic value of patient-described symptoms could improve diagnosis and treatment effectiveness.