Abstract
BackgroundGout is the most common form of inflammatory arthritis and is associated with considerable co-morbidity. It is usually managed in the primary care setting with a combination of lifestyle modification and pharmacological therapy. This study describes patterns of communication about gout observed in interactions between patients and primary care practitioners during routine consultations.MethodsSecondary analysis of video-recordings of individual healthcare consultations between patients and a range of primary care practitioners (including general practitioners, practice nurses, podiatrists and dietitians) from an archived database. Consultations that included any discussion about gout were eligible for inclusion (n = 31) and were not restricted to those where gout was the main presenting complaint. The consultation transcripts were analysed using a qualitative inductive approach from clinical and linguistic perspectives and supplemented with visual observation of the interactions.ResultsTwo main themes emerged from the data; the importance of gout and ‘telling’ versus ‘listening’ in consultations. The first theme had two distinct strands; gout as an incidental part of the consultation and the impact of gout on patients. A trend towards more didactic practitioner communication encompassed by the second theme occurred at many different consultation points including diagnosis, in more general post-diagnosis discussion, and when discussing biochemical test results and lifestyle advice. In contrast, when discussion about treatment with medicines occurred a tendency towards a greater degree of listening to patients was observed.ConclusionOur observation of the communication patterns in these consultations illustrates an inherent complexity of gout consultations in primary care. Gout may be more important to patients than is often apparent to practitioners in routine consultations. Consultation management needs to take into account the impact of the condition and the balance of information provided around lifestyle advice versus long-term management with medicines.
Highlights
Gout is the most common form of inflammatory arthritis and is associated with considerable co-morbidity
Gout is recognised as the most common form of inflammatory arthritis and occurs as a response to the deposition of monosodium urate crystals in the joints [1]. It is associated with a range of co-morbidities including diabetes, hypertension and obesity; it is a chronic condition manifested by acute flares and chronic monosodium urate crystal deposition with differing management options; [1] it is usually managed in primary care
Two key and important themes that emerged from our data relating to the importance of gout and telling versus listening in consultations are the focus of this paper and
Summary
Gout is the most common form of inflammatory arthritis and is associated with considerable co-morbidity. It is usually managed in the primary care setting with a combination of lifestyle modification and pharmacological therapy. Gout is recognised as the most common form of inflammatory arthritis and occurs as a response to the deposition of monosodium urate crystals in the joints [1] It is associated with a range of co-morbidities including diabetes, hypertension and obesity; it is a chronic condition manifested by acute flares and chronic monosodium urate crystal deposition with differing management options; [1] it is usually managed in primary care. The diagnosis can be a source of stigma for patients resulting from the stereotypes that exist around the condition’s perceived link to lifestyle and alcohol use [10,11,12,13]
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
