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Biomedical subjects

K Malterud

Publications and source records attributed to K Malterud.

At least 37 records · Page 2Linked to original sources
PubMed1999

The (gendered) construction of diagnosis interpretation of medical signs in women patients.

Medicine maintains a distinction between the medical symptom--the patient's "subjective" experience and expression, and the privileged medical sign--the "objective" findings observable by the doctor. Although the distinction is not consistently applied, it becomes clearly visible in the "undefined," medically unexplained disorders of women patients. Potential impacts of genderized interaction on the interpretation of medical signs are addressed by re-reading the diagnostic process as a matter of social construction, where diagnosis results from human interpretation within a sociopolitical context. The discussion is illustrated by a case story and empirical evidence of the gendering in the doctor-patient relationship. The theoretical analysis is supported by semiotic perspectives of bodily signs, feminist theory on experience, and Foucault's ideas about medical perception and gaze, and concludes that a medical diagnosis is seldom a biological fact, but the outcome of a process where biological, cultural and social elements are interwoven. Further deconstruction of the chain of signs from a feminist perspective, assigning validity to the voice of the woman patient, might broaden the understanding of women's health, illness and disease.

Attitude of Health Personnel↗
PubMed1999

Approaching the locked dialogues of the body. Communicating symptoms through illness diaries.

OBJECTIVE: To describe and analyse communication following the use of an illness diary method in consultations with patients suffering from longstanding illness without clinical findings. DESIGN: Action research in own practice with qualitative formative evaluation of material provided by the use of the diary method. Analysis followed a procedure modified from phenomenologically-based methodology. SETTING: The practice of the main author. SUBJECTS: 36 consultations with 16 patients where the illness diary method was applied. RESULT: Communication following illness diary utilisation could be summarised as: 1) illness diaries as medical documentation, 2) making access to the insight of the patient, 3) exploring internal dialogues and locked voices, and 4) adding meaning to a spoken message through writing (creative distance). By changing the frames of conversation through illness diary utilisation towards one or more of these four levels of communication, the patient may become a more equal consultation partner. CONCLUSION: Illness diaries can provide clinically relevant information and may emphasise the patient's input and significance in medical dialogues on longstanding symptoms without clinical findings.

Adolescent↗
PubMed1999

Peeing barbed wire. Symptom experiences in women with lower urinary tract infection.

OBJECTIVE: To explore the contents and presentation of symptoms experienced by female patients with lower urinary tract infections. DESIGN: Qualitative study based on written answers to open-ended questions on symptom experiences, analysis with Giorgi's phenomenological approach, explanatory model as frame of reference. SETTING: Twelve general practices in the Bergen area of Norway. SUBJECTS: Ninety-four women aged 19-97 years who consulted because they suspected to have an acute cystitis and who had leucocyturia and growth of 10(5) or more uropathogens/ml in the urine. MAIN OUTCOME MEASURES: Descriptions and nuances considered mainstream for cystitis or as a supplement to the traditional medical symptom descriptions. RESULTS: We found a great diversity of symptoms. Typical symptom descriptions were a terrible scorch when the bladder is nearly empty, frequent need to void followed by only a few drops, sometimes so suddenly that it may go wrong, or a constant ache in the low back and belly. Subjects also described constant aching or pressure in the genital area, or they felt miserable and no good in the whole body. Specific symptoms were also localized elsewhere in the body. CONCLUSION: Diverse symptom descriptions complementing previous knowledge were revealed, as well as symptoms not usually mentioned in textbooks or reviews.

Acute Disease↗
PubMed1999

Encouraging the strengths of women patients. A case study from general practice on empowering dialogues.

This case study illustrates how the use of empowering dialogues in general practice can contribute to alternative images of women, by identifying and emphasizing their strong points. It is a single case study, sampled theoretically from a series of 37 consultations during which key questions about self-assessed health resources were put to women patients. Two women GPs and their consultations were studied. An 18-min dialogue between a 52-year-old woman GP and a 69-year-old woman patient with asthma and back pain was audiotaped and transcribed according to Nessa's principles, supported by pragmatic linguistic theory. The woman's answers changed the doctor's perception of the patient, from that of a passive and resigned sufferer, to that of a strong woman who was active in spite of her pain. Acknowledging this, alternative paths of management could be chosen. In conclusion, disempowering medicalization of women patients can be opposed by resource oriented dialogues in clinical work. However, to change cultural images requires more than individual action.

Adult↗
PubMed1998

[Radiology--an exciting specialty, unsatisfactory training situation?].

Despite the medical and technological advances during the last decade, there have been problems in attracting new recruits for radiology specialization in Norway. The increasing number of vacancies is a cause for concern. To address this problem, we held interviews with six residents--three males and three females aged between 30 and 39 years. They had from four months to three years of experience in diagnostic radiology at the time of the study. The data were analyzed according to the principles of Giorgi. The participants found radiology both interesting and challenging, but considered the specialist training inadequate, mainly because there were too many routine tasks and not enough supervision.

Adult↗
PubMed1998

[Is headache a women's disease?].

Headache is experienced by the majority of people in the population. The prevalence of migraine in women is greater than in men, and there are indications that this is also the case for non-migrainous headache. We reviewed available literature on headache epidemiology for documented knowledge on the prevalence of non-migrainous headache in men and women and severity of the disease. In this article we present a summary of 13 studies of the general population where prevalence of the common headache in men and women could be expressed as a gender ratio. The studies covered the period 1977-96, and included a total number of 75,000 people. The review confirms that non-migrainous headache is a women's disease, in that a female dominated gender ratio was found consistently throughout the studies. However, female dominance is not as great as for migraine. Varying definitions of headache resulted in a great variation in prevalence across the studies, but this did not influence the gender ratio. From the literature available no conclusions can be drawn on gender differences related to severity or frequency of the non-migrainous headache. These areas need to be explored further in order to provide adequate health care for men and women suffering from headache.

Female↗
PubMed1998

Understanding women in pain. New pathways suggested by Umeå researchers: qualitative research and feminist perspectives.

A substantial proportion of GPs' patients are women who suffer from "unexplained" pain conditions, often from the musculoskeletal system. Few medical findings are revealed, although the symptoms lead to extensive suffering and disability. Two experienced Swedish GPs, Katarina Hamberg and Eva E Johansson, took their own frustration as their point of departure to explore the expectations, experiences, family lives and working lives of women who were sick-listed due to chronic musculoskeletal pain. Their doctoral dissertations, defended at the University of Umeå in September this year, are based on a qualitative interview study with 20 women aged 21-61 years. Johansson and Hamberg found that when seeing a doctor, the women expect to be seen, heard and taken seriously, to get information and time for discussion with the doctor, and to receive help and support over time. However, they experienced being ignored, disregarded and rejected. Symptom perception was characterized by loss of control and feelings of threat and unpredictability. The women believed that the pain had a bodily origin triggered by various mechanisms such as heavy and monotonous work, environmental influences, tensions and worries, rightful punishment or heritage. The Swedish study showed that family considerations had a strong impact on organizations and priorities in paid work. In this sample of working class women, family orientation strengthened and works aspiration declined in a situation of pain and sick leave. Problems related to rehabilitation could be explained by looking more closely on home conditions, especially the unwritten deal among the woman and her partner regarding the division of duties and power structure--the marital contract. Experiences of abuse and violence were reported to Hamberg and Johansson by several women, most of them considering this to be one root of their pain and ill health. The women emphasized that an understanding doctor would ask about violence, apprehend the hints, confirm that it was acceptable to talk about it, and avoid the questioning and blame that easily might increase the woman's feelings of guilt.

Absenteeism↗
PubMed1998

"Feeling your large intestines a bit bound": clinical interaction--talk and gaze.

OBJECTIVE: To explore the relationship between observation and talk in the clinical encounter, using the medical gaze as a key metaphor. DESIGN: A qualitative case study approach based on data from one consultation. Two sequences of patient-doctor interaction are the basis of a theoretical discussion of the medical gaze. SETTING: Audiotape recording from a Norwegian general practice. RESULTS: The doctor balances observation and talk to produce an appropriate, but not necessarily the only correct diagnosis. Verbal utterances illustrate how the doctor's structuring of the diagnosis works as an interactional means both to take care of the patient and to explain his sufferings. CONCLUSION: Clinical medicine is talk and gaze as an integral whole. Doctors not only make a diagnosis, but also structure a clinical reality.

Attitude of Health Personnel↗
PubMed1998

Talking with women about personal health resources in general practice. Key questions about salutogenesis.

We want to share experiences from an approach for clinical communication and research, intended to identify and mobilize personal health resources in female patients, and promote strategies for resource oriented talk in general practice. We used an action research design with qualitative evaluation to summarize the process where we developed a key question about self-assessed health resources in women, based on The Health Resource/Risk Balance Model, including salutogenesis, patient-centredness and gender perspectives. From consultations with 49 female patients in our own practices, we have drawn a narrative description of the development process, a summary of issues that facilitated resource talk, and our final version of the key question. We suggest that resource talk is based on 1) an explicit shift of language from disease to health, but nevertheless recognizing the fact that illness occurs, 2) options for answers given by the female patient and not by the doctor, 3) signification of the woman's assessment of her own situation (in contrast to the doctor's assessment), and 4) taking for granted that women's personal health resources exist as numerous strategies which are utilized, and may be identified. We have learnt that communicative action can provide tools for shifting the attention of doctor and patients from risks and diseases to resources and strengths. This is an example of one way to change your practice through systematic reflection in dialogue with a colleague.

Attitude to Health↗
PubMed1998

Gender differences in general practice consultations: methodological challenges in epidemiological research.

BACKGROUND: Women consult their GP more often than men do. The distribution of complaints and diagnoses are different for women and men patients. Although several findings on gender differentials on mortality and health care consumption are rather consistent across studies, detailed findings and subsequent conclusions diverge in several important fields. OBJECTIVES: Our aim was to explore methodological aspects of research on gender differences in general practice. METHODS: We reviewed empirical studies within this field, aiming to identify methodological and interpretative intricacies which deserve special attention in epidemiological research on GP consultations. RESULTS AND CONCLUSIONS: We found that descriptive and explanatory levels of research are frequently confused. Simple questions, answers and explanations are commonly raised for complex issues within a poorly defined theoretical explanatory framework. There is a need to assess relevant approaches for various purposes, and to develop more uniform conceptual terms. Findings from one level are often transferred to another, incompatible level. Epidemiological issues must be considered, especially matters related to denominator level and standardization/confounders-not in order to decide which level represents 'reality', but to clarify the consequences of different measures for different research questions. The contents of the core variables and the potentials for bias should be discussed in order to provide a sound basis for future explanatory studies.

Epidemiologic Research Design↗
PubMed1998

Tell me what's wrong with me: a discourse analysis approach to the concept of patient autonomy.

BACKGROUND: Patient autonomy has gradually replaced physician paternalism as an ethical ideal. However, in a medical context, the principle of individual autonomy has different meanings. More knowledge is needed about what is and should be an appropriate understanding of the concept of patient autonomy in clinical practice. AIM: To challenge the traditional concept of patient autonomy by applying a discourse analysis to the issue. METHOD: A qualitative case study approach with material from one consultation. The discourse is interpreted according to pragmatic and text-linguistic principles and provides the basis of a theoretical discussion of different concepts of patient autonomy. RESULTS: The consultation transcript illustrates how the patient's wishes can be respected in real life. The patient, her husband and the doctor are all involved in the discourse dynamics, governed by the subject matter, namely her mental illness. CONCLUSION: We suggest a dynamic and dialogue-based conception of autonomy as adequate for clinical purposes. These perspectives, based on mutual understanding, take communication between patient and doctor as their starting point. According to this approach, autonomy requires a genuine dialogue, an interpersonal mode of being which we choose to call "authentic interaction".

Depressive Disorder↗
PubMed1997

Not so bad after all..., Women's experiences of pelvic examinations.

OBJECTIVE: We aimed to explore women's experiences of pelvic examinations. METHOD: A qualitative study was carried out with in-depth interviews based on Kvale's principles, analysis using Giorgi's phenomenological approach, and a feminist frame of reference. Purposeful sampling included 13 women of various ages and backgrounds interviewed after a pelvic examination. The main outcome measures were descriptions and concepts reflecting the most important matters experienced by the women. RESULTS: Women are nervous before a pelvic examination, but regard it as a necessary procedure to rule out gynaecological disease. Advance expectations were worse than the actual experience. The women identified several matters as essential for their ability to feel in control during the procedure, such as the doctor's gender, informed communication, positioning during examination, integrity during nakedness, and trust in the doctor. The importance of the different issues varied between women. CONCLUSION: Pelvic examination is a procedure which reveals ambivalence in the women due to its intimate relationship between sex, power, and medical knowledge. The doctor can contribute to empowerment of the women by acknowledging the specific context of the procedure, listening to the voice of the individual patient and respecting the inherent ambivalence of the situation.

Adolescent↗
PubMed1997

What did the doctor say--what did the patient hear? Operational knowledge in clinical communication.

OBJECTIVES: We aim to introduce Piaget's concept of 'operational knowledge' from the cognitive theory of learning--as a contribution to the broader understanding of clinical interaction. METHOD: Our study involves a theoretical presentation of different kinds and levels of human understanding, illustrated by a case story in which the difference between operational and figurative knowledge was demonstrated. This study used the case story of a male patient aged 80, who was suffering from ulcerative colitis. We appealed to the reader's perceived relevance of these perspectives, in order to understand what was going on between doctor and patient. RESULTS: The case story demonstrates the phenomenon of operational knowledge in the patient, the close links between communicative action and cognitive understanding, and the importance for the doctor of reflecting upon this level of interaction. CONCLUSION: According to the patient-centred clinical method, the doctor should explore the social and emotional context of the patient in order to understand the meaning of the illness. We suggest that a cognitive dimension should also be added, and that the concept of 'operational knowledge' might be useful for such investigations.

Aged↗