The aim of this study was to improve medical understanding of patients' illness experience and everyday thinking about physical distress, by focusing on patients' and physicians' narratives of medically unexplained symptoms. Semi-structured interviews were held with 16 Canadian and immigrant patients from two primary care clinics in Montreal, and separately with their physician. Detailed content analysis reveals that, despite the absence of diagnosis, both patient and physicians hold complex and dynamic models of illness. Physicians' explanations rely almost exclusively on biomedical constructs, whereas patients' models of illness draw from a much wider range of sources of experience and authority. Despite regular follow-up, physicians have very limited access to the intricate networks of meaning revealed in their patients' interviews. In fact, although there is some common ground of understanding, patients and physicians show low congruence of their models, and much discrepancy in the expected outcome and management. Eliciting patients' illness narratives rather than focusing on narrow biomedical issues offers promising possibilities for physicians to negotiate meaning with their patients. The richness of patients' models provides potential avenues leading out of the clinical impasse of medically unexplained symptoms.
| Identifer | oai:union.ndltd.org:LACETR/oai:collectionscanada.gc.ca:QMM.101113 |
| Date | January 2006 |
| Creators | Dominicé Dao, Melissa. |
| Publisher | McGill University |
| Source Sets | Library and Archives Canada ETDs Repository / Centre d'archives des thèses électroniques de Bibliothèque et Archives Canada |
| Language | English |
| Detected Language | English |
| Type | Electronic Thesis or Dissertation |
| Format | application/pdf |
| Coverage | Master of Science (Division of Social & Transcultural Psychiatry.) |
| Rights | © Melissa Dominicé Dao, 2006 |
| Relation | alephsysno: 002586682, proquestno: AAIMR32692, Theses scanned by UMI/ProQuest. |
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