Submitting articles to the BMJ |
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| Authors: | Rosemarie McCabe Christian Heath Tom Burns Stefan Priebe |
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| Institution: | aUnit for Social and Community Psychiatry, Barts and the London School of Medicine, Newham Centre for Mental Health, London E13 8SP, bManagement Centre, King''s College London, Franklin-Wilkins Building, London SE1 8WA, cDepartment of Psychiatry, St George''s Hospital Medical School, London SW17 0RE;Interactive Skills Unit, Department of Primary Care and General Practice, University of Birmingham, Birmingham B15 2TT |
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| Abstract: | ObjectiveTo investigate how doctors engage with patients with psychotic illness in routine consultations.DesignConversation analysis of 32 consultations between psychiatrists and patients with schizophrenia or schizoaffective disorder.SettingTwo psychiatric outpatient clinics in east London and south west London.Participants7 psychiatrists and 32 patients with schizophrenia or schizoaffective disorder.ResultsPatients actively attempted to talk about the content of their psychotic symptoms in consultations by asking direct questions, repeating their questions and utterances, and producing these utterances in the concluding part of the consultation. In response, doctors hesitated, responded with a question rather than with an answer, and smiled or laughed (when informal carers were present), indicating that they were reluctant to engage with patients'' concerns about their psychotic symptoms.ConclusionsPatients repeatedly attempted to talk about the content of their psychotic symptoms, which was a source of noticeable interactional tension and difficulty. Addressing patients'' concerns about their illness may lead to a more satisfactory outcome of the consultation and improve engagement of such patients in the health services. What is already known on this topicPatients with psychotic illness are difficult to engage in the health servicesNo research has been published on how doctors engage with these patients in consultationsWhat this study addsPatients actively attempt to talk about the content of their psychotic symptomsDoctors'' reluctance and discomfort in engaging with this topic is apparentAddressing patients'' concerns may lead to a more satisfactory outcome of the consultation and improve engagement with services |
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