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Biomedical subjects

K Malterud

Publications and source records attributed to K Malterud.

At least 19 recordsLinked to original sources
PubMed2001

[A shared room of reflection where the patient's symptoms are valid sources of knowledge].

BACKGROUND: The consultation is supposed to clarify the origin of the patient's complaints and what can be done to alleviate them. Diagnostic work and interaction are challenged by subjective symptoms with no objective findings. In our project "Symptoms as a source of knowledge" we studied women's medically unexplained disorders from the viewpoint that the patient's knowledge represents significant potential for creative understanding. MATERIAL AND METHODS: Concepts and hypotheses about symptoms applied as diagnostic sources of knowledge were drawn from qualitative analysis of findings from the subprojects. We have explored issues of relevance and validity that shape the consultation as a medical and cultural space. RESULTS: Symptoms beyond established categories can disturb a room of reflection which includes patient as well as doctor. The patient may feel dismissed as a person, the process of objectivising becomes defocused, and the diagnostic activity deals with the patient's credibility. Signs related to "either-or" appear as a more comprehensible medical pattern than signs of 'more-or-less'. The probability of a common room of reflection may be related to cultural attitudes to time, blame, and womanliness. INTERPRETATION: When traditional medical analytic tools fail, alternative rooms of reflection can be established from recognition, resources, and dialogue, enhancing surprises and curiosity.

Clinical Competence↗
PubMed2001

[Subjective symptoms without objective findings--a challenge for theory and practice of general medicine].

Most practitioners know patients who suffer from subjective symptoms, although the doctor cannot find any objective findings or causal explanations. The majority of patients with medically unexplained disorders are women. In this article, I challenge the idea that these disorders are really unexplainable and inaccessible to diagnosis, treatment, or therapy. I present some experiences and findings from the research project "Symptoms as a source of medical knowledge", where an objective is to develop strategies where the patient's symptom experiences can be used to enhance the doctor's understanding of apparently unexplained disorders, their origins and consequences. Applying the theoretical framework of "recognition" and "empowerment", I propose some strategies intended to help the practitioner to encounter these challenges in everyday clinical practice.

Diagnosis, Differential↗
PubMed2001

Qualitative research: standards, challenges, and guidelines.

Qualitative research methods could help us to improve our understanding of medicine. Rather than thinking of qualitative and quantitative strategies as incompatible, they should be seen as complementary. Although procedures for textual interpretation differ from those of statistical analysis, because of the different type of data used and questions to be answered, the underlying principles are much the same. In this article I propose relevance, validity, and reflexivity as overall standards for qualitative inquiry. I will discuss the specific challenges in relation to reflexivity, transferability, and shared assumptions of interpretation, which are met by medical researchers who do this type of research, and I will propose guidelines for qualitative inquiry.

Guidelines as Topic↗
PubMed2001

The art and science of clinical knowledge: evidence beyond measures and numbers.

Medical doctors claim that their discipline is founded on scientific knowledge. Yet, although the ideas of evidence based medicine are widely accepted, clinical decisions and methods of patient care are based on much more than just the results of controlled experiments. Clinical knowledge consists of interpretive action and interaction-factors that involve communication, opinions, and experiences. The traditional quantitative research methods represent a confined access to clinical knowing, since they incorporate only questions and phenomena that can be controlled, measured, and counted. The tacit knowing of an experienced practitioner should also be investigated, shared, and contested. Qualitative research methods are strategies for the systematic collection, organisation, and interpretation of textual material obtained from talk or observation, which allow the exploration of social events as experienced by individuals in their natural context. Qualitative inquiry could contribute to a broader understanding of medical science.

Clinical Competence↗
PubMed2001

From exercise and education to movement and interaction. Treatment groups in primary care for women with chronic muscular pain.

OBJECTIVE: To develop a group-based treatment programme in primary health care for women with chronic muscle pain, and adjust programme development according to experiences obtained by the participating women and health personnel. The aim of the programme was to help the women develop a tool for handling their chronic state of pain. The article describes and discusses experiences essential for elaboration of the treatment programme. DESIGN: Action research design. SETTING: Existing therapy groups in Stovner for women with chronic muscle pain. SUBJECTS: We arranged eight treatment groups, each lasting 12 weeks, and three groups lasting 10 months, with a total of 133 participants. MAIN OUTCOME MEASURES: Experiences were systematised by means of pragmatic analysis of qualitative data from field notes, tape recordings of focus group interviews, and video recordings of training and discussion groups. RESULTS: While initially the training programme aimed at increasing physical fitness and muscle strength, it gradually developed into activity based on movement with an emphasis on noticing and experiencing. The instruction programme initially aimed at providing information, and developed towards discussion groups with emphasis on mutual understanding and recognition. CONCLUSIONS: The training programme is now concentrated on a few, simple exercises and is characterised by awareness of the relationship between breathing and muscle tension. Groups were found to be the main pillar of the programme, characterised by security and a feeling of belonging with room for reflection and development.

Adult↗
PubMed2001

Unravelling empowering internal voices-a case study on the interactive use of illness diaries.

BACKGROUND: The article is part of a study of an illness diary method for improving clinical communication with patients suffering from long-standing illness without clinical findings. OBJECTIVE: The aim of this study was to demonstrate how patient empowering can be approached through a process of shared insight in a personal illness description. METHODS: This was a single case study from three encounters with a 48-year-old woman suffering from headache, who participated in the illness diary study. Theoretical sampling was used to select the presented case from the sample. The material comprises sections of notes and transcripts from audiotapes. RESULTS: During the encounters, the medical dialogue is changed to include the patient's internal dialogues on her illness and her ways of coping. Her body language is approached and met, and its empowering potential is explored in the dialogue. CONCLUSION: The reflective practitioner may contribute to transform a consultation from repetitive patterns to a dialogue based on the patient's own coping resources.

Adaptation, Psychological↗
PubMed2001

Management of dementia in primary health care: the experiences of collaboration between the GP and the district nurse.

OBJECTIVE: The objective of this study was to explore the context and experiences of collaboration between the GP and the district nurse (DN) in diagnosing dementia, in order to identify possible procedures to improve care. METHODS: Two group interviews were conducted with four DNs and five GPs, respectively, working in the municipality of Copenhagen. RESULTS: The group interviews revealed that the suboptimized collaboration could be due to different inter-professional diagnostic strategies and a lack of understanding of the importance of early, shared, decision making. This could create conflicts between the groups. CONCLUSIONS: This study indicates a possibility for improved collaboration between the two professional groups in diagnosing dementia. Possible approaches for improved care should focus on an inter-professional understanding of the importance of early, shared, decision making, emphasizing early identification and care of diagnosed demented patients. Establishing a shared collaboration model including out-patient memory clinics, GPs and DNs could be a first step. This model should also take into account an evaluation of possible consequences for the diagnosed demented patients in terms of treatment and care and consider the indication for referrals to a comprehensive diagnostic evaluation. We are at present planning a study to address these aspects.

Adult↗
PubMed2001

The purpose of the general practice consultation from the patient's perspective--theoretical aspects.

BACKGROUND: Medical practice and research are paying increasing attention to what patients want, as reflected by the growth of routine surveys of patients' satisfaction and more formal studies of patients' views of medical care. However, the field lacks conceptual clarity. OBJECTIVES: The aim of this study was to propose a theoretical clarification of the concept of the patients' purpose of a consultation by presenting a patient-centred definition, applicable for clinical work and research in general practice. METHODS: An extensive literature review was conducted to explore presumptions and definitions reported by previous studies. Most authors failed to define or distinguish the concept under investigation. We took these shortcomings as our starting point, added some significant dimensions drawn from a few selected authors who had discussed relevant perspectives in their work and arrived at a proposed working definition of the 'purpose' concept. RESULTS: The proposed definition allows for multiple purposes for the consultation. We incorporate what the patient hopes to gain from the consultation, as opposed to their 'expectations of the most likely outcome'. Our working definition aims to identify patients' a priori wishes and hopes for a specific process and outcome, while acknowledging that these may not be voiced and may be modified by the patient during the consultation. General characteristics of the doctor, such as being considerate or professionally skillful, are not included.

Communication↗
PubMed2001

Gendered health resources and coping--a study from general practice.

AIM: The aim of this study was to explore gender and coping in primary health care patients, by comparing self-assessed health resources in men and women. METHODS: Female and male patients' self-assessed health resources were identified by mean of key questions, developed separately for men and women. Patients' answers were audiotaped and analyzed qualitatively. An explorative gender comparative analysis was done. The setting comprised two women GPs and their consultations. The subjects were 37 consecutive female patients and 39 consecutive male patients aged 19-85 years. RESULTS: The analysis indicated notable differences in spite of apparent similarities in self-assessed personal health resources in men and women. In men, personal strength was part of a proud identity, while women reported that they were able to manage because they just had to. Work was often mentioned as a health resource, but while men emphasized their well-being at work and a capacity to relax at home, women handled stressful tensions by diving into household activities. While men spoke of gaining health from being with others, women talked about social relations as contexts for gaining as well as giving health. CONCLUSION: None of the phenomena described by the respondents can be reasonably categorized as respectively problem-focused, emotion-focused or avoidance coping strategies. Asking people about their own ideas regarding health resources may provide more complex understandings of coping and gender. In a clinical setting skilful listening can prevent gender essentialism, where all men are regarded as different from all women.

Adaptation, Psychological↗
PubMed2000

[Symptoms in women with Sjogren's syndrome].

More knowledge about symptom experience is needed for diagnosing Sjögren's disease at an early stage of disease development. We have performed a qualitative study based on group interview with eight women with Sjögren's disease. The women presented with several different symptoms. They all described weariness, fatigue, sicca symptoms, various pains, hypersensitivity and organ manifestations in the same manner. Some of the symptoms had a dramatic impact on their life activities. The study revealed new descriptions of previously known symptoms and descriptions of previously unfamiliar symptoms. The results of the study may supplement the existing criteria of Sjögren's disease and provide new hypotheses about pathogenetic mechanisms related to chest pain, abdominal pain and facial pain in patients with Sjögren's disease.

Activities of Daily Living↗
PubMed2000

From risk factors to health resources in medical practice.

The healing and preventive powers of people's health resources and self-assessed knowledge have so far been grossly underestimated in medicine. In this article, we call attention to ethical and epistemological dilemmas related to knowledge, values, communication, and autonomy embedded in the prevailing risk-oriented epidemiology, and suggest a patient-centred salutogenetic approach to promote a better balance between resources and risks in medicine. Identification and intervention upon risk factors can provide hypotheses about origins of disease and predict and sometimes prevent disease at a group level. However, there are several pitfalls related to this perspective concerning causal factors, group level based possibilities, adequate end points for intervention, informed consent, and medicalization, especially in the individualized context of the clinical encounter. By introducing a salutogenic perspective, we urge to shift the attention toward resources, agency and strength, which may counteract risk of disease and empower the patient. Talk can mediate oppression as well as empowerment. A communicative key question approach, and self-assessed health resources identified through this strategy, are briefly presented as examples of empowerment through dialogue.

Communication↗
PubMed2000

"I could not lift my arm holding the fork...". Living with chronic fatigue syndrome.

OBJECTIVES: To explore and describe symptoms and their consequences for patients suffering from chronic fatigue syndrome (CFS). DESIGN: Qualitative data from a group interview, written answers to a questionnaire and a follow-up meeting analysed in accordance with Giorgi's phenomenological approach. SUBJECTS: Purposeful sample of 10 women and 2 men of various ages recruited from the local self-help patient organisation. MAIN OUTCOME MEASURES: Descriptions reflecting the nature, extent and consequences of symptoms regarded as the most substantial by the informants across the group. RESULTS: Extreme exhaustion exceeding the nature of everyday weariness was reported as the worst symptom. The informants perceived reduced muscular strength, continuous weakness and recurrent pain, problems related to memory and concentration, sleep disturbances and excessive sensitivity towards smell, light and sound. Learning abilities had deteriorated, and housework, conversation, reading and watching TV were characterised as exhausting, leading to an unpredictability of everyday life-disturbing social relations. CONCLUSION: The extent and nature of symptoms suggest that CSF is an essentially different and far more serious condition than the strains of everyday life. Our findings suggest immunological processes affecting the neuromuscular and central neural system comparable to the effects of cytostatic medication.

Adult↗
PubMed2000

Men's self-assessed personal health resources: approaching patients' strong points in general practice.

OBJECTIVE: To explore resource-oriented, gender-sensitive approaches in general practice by identifying what men perceive to be their personal health resources. METHODS: A key question was developed to invite men to tell their GPs about personal health resources during ordinary visits. The answers of 39 consecutive male patients (aged 19-84 years) visiting two female GPs were audio taped and analysed, qualitatively inspired by Giorgi's phenomenological approach, supported by theories on salutogenesis, patient-centredness and gender perspectives. The main outcome measures were personal qualities and strategies considered by men to be their health resources. RESULTS: Men considered that the following were personal health resources: optimism, good self-esteem, job satisfaction, ability to cope with stress at work, leisure activities and relaxation with friends producing energy, and fitness and lifestyle activities. CONCLUSION: A key question can give a doctor access to men's thoughts about their strong points. Self-assessed personal health resources can be identified and mobilized by the GP and support a salutogenic approach, which contrasts with the tendency of contemporary medical practice to focus on risk. Asking people about their own ideas may reveal that coping patterns are more complex than reflected in prevailing research.

Adaptation, Psychological↗
PubMed2000

Symptoms as a source of medical knowledge: understanding medically unexplained disorders in women.

In cases where a traditional medical frame of reference does not fully offer an adequate tool for understanding, the resident may find it perplexing to apply knowledge from medical school, where disease implies symptoms, findings, diagnosis, and cure. Medically unexplained disorders, mostly occurring in women, are chronic and disabling conditions, presenting with extensive subjective symptoms, although objective findings or causal explanations are lacking. Acquiring the knowledge and skills needed for adequate care of patients with chronic fatigue or pain syndromes is not an easy task. This paper presents a strategy for teaching, intended to facilitate understanding through appreciation of symptoms as a source of knowledge. The clinical approach is based on empowering practices supported by theoretical perspectives about signs, narratives, knowing, and gender. Also examined is the impact of commonly occurring teaching traps related to gender, psychosocial labeling, universalistic understanding, omnipotence, and power.

Chronic Disease↗
PubMed1999

[Chronic somatic illness--illness diaries written at home give possibilities for communication about the body].

The article presents the development and qualitative evaluation of a clinical communicative method based on illness diaries used in consultations with patients suffering from long-standing illness without clinical findings. The article is based on action research in the authors' own practice. Data were collected from 36 consultations with 16 patients where the illness diary method was applied. Analysis followed a procedure modified from phenomenologically based methodology. The method has gradually been elaborated according to utilization experiences on an interactional level, leading to a more specific presentation of the method and its use. Communicative strategies arising from illness diary utilization could be summarized as: using illness diaries as medical documentation; getting access to the patient's insight; exploring internal dialogues and locked voices; and adding meaning to a spoken message through writing. When the framework of conversation is changed through illness diary utilization towards one or more of these four levels of communication, the patient may become a more equal consultation partner. Illness diaries can provide clinically relevant information and may emphasize the patient's input and significance in medical dialogues on long-standing symptoms without clinical findings.

Adolescent↗