当患者拒绝:在美国初级保健中抵制诊断关闭
1UCLA Department of Sociology, 375 Portola Plaza, Los Angeles, CA, 90095, USA.
Social science & medicine (1982)
|February 3, 2024
概括
患者越来越多地参与医疗保健,但医生权威限制了他们在诊断期间的投入. 患者使用"诊断不确定性"以尊重地表达关切,平衡参与与对医疗专业知识的尊重.
科学领域:
- 医疗保健服务研究 医疗服务研究
- 医学社会学 医学社会学
- 对话分析 对话分析
背景情况:
- 患者参与医疗保健决策的比例正在上升.
- 在初级保健中,医生权威往往主导了诊断推理.
- 诊断结束后,患者有有限的机会表达关切.
研究的目的:
- 检查患者在急性初级保健中的诊断感知过程中如何表达关切.
- 介绍和定义"诊断不良"的概念.
主要方法:
- 使用对话分析.
- 分析了75个美国急性初级保健接触的视频录像.
主要成果:
- 患者经常使用"诊断失败"来抵制诊断关闭.
- 死亡发生在初级诊断时刻之外,尊重医生的权威.
- 患者利用个人疾病经验以微妙地表达他们的担忧.
结论:
- 患者在增加参与和对医疗权威的尊重之间进行复杂的动态导航.
- 诊断demurral是患者参与的关键策略,尽管有互动约束.
- 患者参与诊断是由医疗遭遇的历史力量动态所塑造的.
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