Positive self-assessed general health in patients with medical problemsA qualitative study from general practice

Abstract

Background Patient and doctor do not always agree on the status of the patient's health. By underestimating the patient's strong sides, the doctor may be contributing to disempowerment and bypassing knowledgeneeded for adequate medical diagnosis and management.Design Prospective study.ObjectiveTo understand how our patients with medical problemsassess their general health as good.Design and setting Qualitative observational study based onaudiotaped material from general practice consultations in authors' practices (Norway and Denmark). The patients were asked to rate their current state of health on a scale ranging from zero to 100, andthen to explain their score.Subjects From 41 consecutive consultations we compiled a purposeful sample of 12 patients who reported positive self-assessedgeneral health although medical problems were present. The 7 women and 5 men were aged between 43 and 96 years, and had been diagnosed with musculoskeletal disorders, heart disease, cancer, depression,headache or severe menopausal symptoms.Main outcome measures Salutogenesis, represented by the authors' Health Resource/Risk Balance Model, and Antonovsky’s Sense of Coherence (SOC) concept comprised the theoretical framework. Transcripts from audiotaped consultations were used for qualitativetext condensation analysis, inspired by Giorgi's phenomenological method. Analysis was theory-driven, applying comprehensibility,manageability and meaningfulness as entries to elaborate patients' accounts of positive health.Results Patients' answers demonstrated how a feeling of logicalreasoning related to symptom perception could provide comfort and sometimes lead to advantageous coping strategies. Personal and socialresources were mentioned as essential means for tolerating and managing the burden of disease. Even fairly extensive endeavours could be experienced as worthwhile when sometimes providing relief, even only temporarily.Conclusion Patients' accounts of general health can challenge thetraditional medical views on assessment of health and disease.