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Patienten som person: om mening och dialog i allmänmedicinsk praktik
Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Social medicine.
1999 (Swedish)Doctoral thesis, comprehensive summary (Other academic)
Place, publisher, year, edition, pages
Umeå: Umeå Universitet , 1999. , 128 p.
Series
Umeå University medical dissertations, ISSN 0346-6612 ; 585
Keyword [en]
general practice, meaning, dialogue medicine, doctor-patient relation, narrative, fibromyalgia, health, empirical phenomenological psychological method, critical reflection, case analysis
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
URN: urn:nbn:se:umu:diva-96897ISBN: 91-7191-599-0 (print)OAI: oai:DiVA.org:umu-96897DiVA: diva2:769108
Public defence
1999-04-16, Samhällsvetarhuset, hörsal B, Umeå universitet, Umeå, 09:00
Projects
digitalisering@umu
Note

Diss. Umeå : Umeå universitet, 1999, Härtill 7 uppsatser.

Available from: 2015-01-23 Created: 2014-12-05 Last updated: 2015-04-09Bibliographically approved
List of papers
1. The importance of a holistic concept of health for health care: Examples from the clinic
Open this publication in new window or tab >>The importance of a holistic concept of health for health care: Examples from the clinic
1993 (English)In: Theoretical Medicine, ISSN 0167-9902, Vol. 14, no 4, 325-342 p.Article in journal (Refereed) Published
Abstract [en]

One of my main points in this study is that the knowledge of orthodox medical theory is an incomplete guide for practical action when relating to our patients' specifically human problems. By following a holistic perspective on patients' health and on our medical enterprise we will be more efficient as doctors. This standpoint is illuminated by means of two case reports. Instead of focusing on symptoms as such and letting them refer to orthodox medical theory, I explicitly relate to the patients as if they are conveying a personal meaning by means of experienced symptoms. The experience of illness could be a successful strategy on the existential level although destructive on the technical biological level. A holistic theory of health can give doctors a good conceptual base when relating to people whose presented illnesses are to be regarded explicitly as their way of making themselves understood. The doctor's understanding of the patient's illness, of the theory of health, and of how health is regained, is dependent on the doctor's having the courage to reduce the distance to the patient, the courage to participate and be changed.

Place, publisher, year, edition, pages
Kluwer Academic Publishers, 1993
Keyword
holistic concept of health, interaction, liberating praxis, symbol science
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:umu:diva-98520 (URN)10.1007/BF00996340 (DOI)
Available from: 2015-01-23 Created: 2015-01-23 Last updated: 2015-01-23Bibliographically approved
2. Health promotion in general practice: on meanings and aims in interaction
Open this publication in new window or tab >>Health promotion in general practice: on meanings and aims in interaction
1994 (English)In: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 4, no 2, 119-124 p.Article in journal (Refereed) Published
Abstract [en]

The enterprise of health promotion in medicine involves a responsibility of distinguishing between the concepts of health and absence of disease and of reflecting on the notions of illness and sickness. In this paper the importance of human dialogue is stressed both as a means and end of the doctor-patient relationship and as the main means of genuine health promotion. The outcome of health work is proposed to depend mainly on the way the patients are encountered. Their efforts to make themselves seen as being sick should not on all occasions be diagnosed and treated. By means of a reflected, dialogic practice patients may be listened to and inspired to reconstruct their symbol-based relationship to the world of meaning. The conception of health primarily includes man's relationship to himself. Illness is looked upon as the subject's experience of illhealth, whereas disease is understood as a functional imbalance of bodily organs. There is a tacit meaning in being ill (and found sick) that can be realized and attended to best in close relationship with the patient. Physicians – preferably general practitioners – involved in health promotion should, it is concluded, both assist the patients to give up their sick role and continually elaborate their own professional competence to see and successfully encounter the manifold specifically human issues underlying their patients' presented symptoms. health promotiondisease preventiongeneral practiceinteractionaction research.

Place, publisher, year, edition, pages
Oxford University Press, 1994
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:umu:diva-98529 (URN)10.1093/eurpub/4.2.119 (DOI)
Projects
digitalisering@umu
Available from: 2015-01-23 Created: 2015-01-23 Last updated: 2017-12-05Bibliographically approved
3. Health promotion and clinical dialogue
Open this publication in new window or tab >>Health promotion and clinical dialogue
1995 (English)In: Patient Education and Counseling, ISSN 0738-3991, E-ISSN 1873-5134, Vol. 25, no 3, 247-256 p.Article in journal (Refereed) Published
Abstract [en]

Clinical medicine would gain from a discussion of the significance of health promotion. Some central concepts are discussed: the diagnostic process; disease prevention vs. health promotion; the practical importance of the understanding of the difference between the 2 concepts health and absence-of-disease. The concept of health catches the intra-personal level, the undisrupted self, whereas absence of disease concerns the proper functioning of the organism, the human biology. By means of comparing 2 diagnoses, multiple sclerosis (MS) and fibromyagia syndrome (FS), it is argued that there are diagnoses of at least 2 distinct kinds. The diagnosis of MS is similar to a scientific discovery, whereas the diagnosis of FS is constructed more like criminal law. Consequently, diagnosis-based disease prevention and health promotion have to comply with a wide range reality. Finally, clinical dialogue is pointed out as a method that successfully combines diagnostic, preventive and promotive efforts, as well as clinical care and cure.

Place, publisher, year, edition, pages
Elsevier, 1995
Keyword
Diagnostic process, Fibromyalgia syndrome, Clinical dialoguel, Clinical health promotion, Disease prevention, Patient education
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:umu:diva-98526 (URN)10.1016/0738-3991(95)00802-7 (DOI)
Available from: 2015-01-23 Created: 2015-01-23 Last updated: 2017-12-05Bibliographically approved
4. A phenomenological analysis of doctor-patient interaction: a case study
Open this publication in new window or tab >>A phenomenological analysis of doctor-patient interaction: a case study
1998 (English)In: Patient Education and Counseling, ISSN 0738-3991, E-ISSN 1873-5134, Vol. 33, no 1, 83-89 p.Article in journal (Refereed) Published
Abstract [en]

The fact that the biomedical model has been very successful in practice does not preclude that some health issues can be understood by way of other health care perspectives. Acquiring skills in meeting patients requires theories that structure other fields of knowledge than the biomedical sciences. An old man, who experiences himself as deeply misunderstood by the medical profession, is interviewed, his personal life-story is gone into and his case records and other available data are analysed. A phenomenological method is used, i.e. disciplined and rigorous reflection upon available data, remaining close to the particular pieces of the patient's narrative as they stand forth in their contextual relationships. The study shows that the doctors involved did not relate to the patient but to a biomedical image of him. His efforts to make himself understood were converted into instrumentally manageable disorders. Finally, dialogue medicine is briefly introduced as a model for counselling patients, especially when they need assistance to abandon the notion that they have been afflicted with a disease, a perception that might serve the purpose of keeping a threatening self-image out of consciousness.

Place, publisher, year, edition, pages
Elsevier, 1998
Keyword
Phenomenological method, Clinical narrative, Dialogue medicine, Patient counseling
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:umu:diva-98524 (URN)10.1016/S0738-3991(97)00058-X (DOI)
Available from: 2015-01-23 Created: 2015-01-23 Last updated: 2017-12-05Bibliographically approved
5. Doctors' attitudes to fibromyalgia: a phenomenological study
Open this publication in new window or tab >>Doctors' attitudes to fibromyalgia: a phenomenological study
Show others...
1998 (English)In: Scandinavian Journal of Social Medicine, ISSN 0300-8037, Vol. 26, no 3, 232-237 p.Article in journal (Refereed) Published
Abstract [en]

Besides specific technical skills, successful encounters with patients require an understanding of the many ways in which patients may express themselves. This qualitative study reports on the clinical experiences of doctors when meeting patients with fibromyalgia (FM). Ten strategically chosen rheumatologists and 10 GPs in central Sweden were interviewed. The interviews were taped, transcribed and analysed in accordance with the empirical, phenomenological, psychological method. The analyses indicate that doctors try to comply with the wishes and demands of patients, and at the same time avoid perceptions of personal frustration. They are inclined to be objective and to act instrumentally, apparently in order to keep in touch with what gave biomedical meaning to an otherwise incomprehensible phenomenon. The meaning structures revealed by doctors' descriptions of FM and of relating to FM patients were characterized mainly by the way in which the doctors were (i) managing their clinical uncertainty, (ii) adhering to the biomedical paradigm, (iii) prioritizing diagnostics, (iv) establishing an instrumental relationship, and (v) avoiding recognizing FM as a possible biomedical anomaly.

Place, publisher, year, edition, pages
Taylor & Francis, 1998
Keyword
Fibromyalgia, Physician Attitudes, Sweden, Phenomenological Research, Funding Source, Interviews, Physician-Patient Relations, Physicians, Family, Patient Education, Human
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:umu:diva-98522 (URN)9768454 (PubMedID)
Available from: 2015-01-23 Created: 2015-01-23 Last updated: 2015-01-23Bibliographically approved
6. A phenomenological study of fibromyalgia: Patient perspectives
Open this publication in new window or tab >>A phenomenological study of fibromyalgia: Patient perspectives
Show others...
1999 (English)In: Scandinavian Journal of Primary Health Care, ISSN 0281-3432, E-ISSN 1502-7724, Vol. 17, no 1, 11-16 p.Article in journal (Refereed) Published
Abstract [en]

OBJECTIVE: To describe the way in which the fibromyalgia patients understand the meaning of their illness. DESIGN: Qualitative, empirical phenomenological psychological method. SETTING: A collaborative transdisciplinary interview study of patients' described experiences of living with fibromyalgia. No therapeutic relationships existed between patients and researchers. SUBJECTS: Eighteen patients with fibromyalgia were interviewed. Ten of the 18 taped interviews were transcribed and analysed. MAIN OUTCOME MEASURES: Patients' narratives, described experiences of living with fibromyalgia. RESULTS: The patients were intensively involved in efforts to get their self-images as ill persons confirmed. Their experience was that the disease started dramatically, with a variety of capriciously appearing symptoms of unknown cause that gave rise to the suffering. The fibromyalgia patients seemed to develop strategies to cope with a precarious self-image and find ways to manage the thought of what the future would bring. CONCLUSION: The meaning structures revealed in the patients' ways of describing their experiences of living with fibromyalgia seemed to be partially constituted by their efforts to stand forth as afflicted with a disease, which could be a way to help them to manage the demands that they placed upon themselves.

Place, publisher, year, edition, pages
Taylor & Francis, 1999
Keyword
Fibromyalgia -- Psychosocial Factors, Patients -- Psychosocial Factors, Qualitative Studies, Phenomenological Research, Empirical Research, Interviews, Audiorecording, Thematic Analysis, Fibromyalgia -- Symptoms, Attitude of Health Personnel, Female, Male, Adult, Middle Age, Funding Source, Human
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:umu:diva-98523 (URN)10229986 (PubMedID)
Note

PMID: 10229986

Available from: 2015-01-23 Created: 2015-01-23 Last updated: 2017-12-05Bibliographically approved
7. Dialogue medicine: a health-liberating attitude in general practice
Open this publication in new window or tab >>Dialogue medicine: a health-liberating attitude in general practice
1998 (English)In: Patient Education and Counseling, ISSN 0738-3991, E-ISSN 1873-5134, Vol. 35, no 3, 221-231 p.Article in journal (Refereed) Published
Abstract [en]

Dialogue medicine is presented as the prime means of understanding patients' illnesses. It is a practical attitude especially aimed to assist or inspire patients to consider, see and manage their illness–demanding efforts to unwittingly suppress or disguise such self-reproaching thoughts as are worse to bear than the feeling of being afflicted with a disease. Along with diagnosing patients' perceived bodily disorders, doctors can choose to see them as persons whose ailments stand for efforts to manage their existence as communicative human beings. The core of the paper is an encounter between the author and a female patient which illuminates the usefulness of genuine dialogue in medical practice. The paper illustrates how the dialogical attitude helps patients to see and manage their difficult life-situations and how the doctor can be inspired to change and develop and improve his/her skills as a dialogue partner. Doctors' dialogical attitude in the encounter encompasses for example openness, empathy, sensitivity, courage, attentiveness and responsiveness, accompanied by concern, trust, respect, affection, appreciation and hope. The philosophical and theoretical foundations of the concept of dialogue medicine are sketched out and some practically significant traits are described.

Place, publisher, year, edition, pages
Elsevier, 1998
Keyword
Dialogue medicine, Doctor–patient relationship, Doctor–patient interaction, Health-liberation, General practice
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:umu:diva-98527 (URN)10.1016/S0738-3991(98)00067-6 (DOI)
Available from: 2015-01-23 Created: 2015-01-23 Last updated: 2017-12-05Bibliographically approved

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Citation style
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  • vancouver
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  • de-DE
  • en-GB
  • en-US
  • fi-FI
  • nn-NO
  • nn-NB
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  • Other locale
More languages
Output format
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  • asciidoc
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