برداشت بیماران از مراقبت های پزشکی در سندرم خستگی مزمن
|کد مقاله||سال انتشار||مقاله انگلیسی||ترجمه فارسی||تعداد کلمات|
|33131||2001||6 صفحه PDF||سفارش دهید||3746 کلمه|
Publisher : Elsevier - Science Direct (الزویر - ساینس دایرکت)
Journal : Social Science & Medicine, Volume 52, Issue 12, June 2001, Pages 1859–1864
This study investigated perceptions of medical care among patients with chronic fatigue syndrome (CFS) referred to a specialist clinic. Sixty-eight patients completed a questionnaire survey on their overall satisfaction with medical care received since the onset of their illness, and their views on specific aspects of care. Two-thirds of patients were dissatisfied with the quality of medical care received. Dissatisfied patients were significantly more likely to describe delay, dispute or confusion over diagnosis; to have received and rejected a psychiatric diagnosis; to perceive doctors as dismissive, skeptical or not knowledgeable about CFS and to feel that the advice given was inadequate or conflicting. Satisfied patients were significantly more likely to perceive doctors as caring, supportive and interested in their illness; to state that they did not expect their doctors to cure CFS and to perceive their GP or hospital doctor as the source of greatest help during their illness. Many patients were critical of the paucity of treatment, but this was not associated with overall satisfaction. The findings suggest that medical care was evaluated less on the ability of doctors to treat CFS, and more on their interpersonal and informational skills. Dissatisfaction with these factors is likely to impede the development of a therapeutic doctor–patient alliance, which is central to the effective management of CFS. The findings suggest a need for better communication and better education of doctors in the diagnosis and management of CFS.
Chronic fatigue syndrome (CFS) is characterised by medically unexplained, disabling physical and mental fatigue that can persist for many years (Sharpe et al., 1991). It is a poorly understood condition, of uncertain aetiology and little in the way of established treatment. In such circumstances, the quality of the doctor–patient relationship is central: problems in the relationship may contribute to persistent disability, whereas a therapeutic alliance is recommended as a pre-requisite for effective management (Royal Colleges of Physicians, Psychiatrists and General Practitioners, 1996). Unfortunately, such an alliance can be difficult to establish: many doctors are dissatisfied with or uncertain about the care they provide; they often find consultations difficult, and some see CFS as a “heartsink” condition (Broom & Woodward, 1996; Fitzgibbon, Murphy, O’Shea, & Kelleher, 1997; Ridsdale, Evans, & Jerrett, 1994; Woodward, Broome, & Legge, 1995). For some CFS patients, consultations with doctors can be equally problematic. In the UK, two small qualitative studies found that many members of CFS patient associations were unhappy with the support and information offered by doctors, and that miscommunication, dismissal and disbelief were widely reported, particularly by women (Ax, Gregg, & Jones, 1997; Cooper, 1997). An American survey of a CFS patient association found that members were significantly more dissatisfied with medical care and more litigious than general medical patients (Twemlow, Bradshaw, Coyne, & Lerman, 1997). In Australia, a qualitative study of 50 patients who managed their illness outside the medical system found that two-thirds had experienced difficulties or dispute over the process of diagnosis, with women more likely than men to report unhelpful or distressing consultations (Broom & Woodward, 1996; Woodward et al., 1995). These studies focused on patients recruited from non-medical settings: the views expressed may not be representative of CFS patients seeking medical care, and there may have been a selection bias towards those who were already dissatisfied (Cooper, 1997). Also, the diagnosis of CFS was only established objectively in the Australian study. It is possible that some of the patients in the UK and American studies had alternative medical or psychological disorders, which may have shaped their experiences of medical care. In general, CFS patients tend to be high users of medical care, and often consume excessive amounts of time in consultations (Ho-Yen & McNamara, 1996; Lloyd & Pender, 1992). It would be helpful to know how CFS patients recruited from within the medical system feel about the care they receive. This may help doctors to identify and modify sources of tension, and help to build a therapeutic alliance. The purpose of the present study was to examine perceptions of CFS patients seeking medical care, in order to discover how such care is evaluated and to identify specific aspects of medical care associated with satisfaction or dissatisfaction. Since there is some evidence to suggest that men and women with CFS perceive medical care differently, gender differences were also examined.