Key questions--a strategy for modifying clinical communication. Transforming tacit skills into a clinical method.

Abstract:

BACKGROUND:A clinical communicative method designed to promote the doctor's understanding of women's "undefined" disorders is presented and discussed. The method is composed of key questions, which are problem-oriented speech acts, inviting the patient to share with the doctor her conception of illness. The questions are directed towards specific clinical problems, and are not meant as global devices for better doctor-patient communication in general. PROCEDURE:The clinical method is the outcome of a procedure where key questions are systematically developed. The procedure starts with individual successful communicative experiences and moves towards questions that are applicable towards various patients presenting the actual clinical problem. The procedure is described qualitatively, and delivers cues from which the modes of asking can be adjusted and employed by other doctors. OUTCOMES:The procedure consists of these steps: 1) declaring the clinical problem for investigation, 2) specifying a relevant communicative intention, 3) assigning fertile themes of knowledge, 4) identifying an efficacious utterance for further refinement, and 5) expanding the validity of the utterance. CONCLUSION:By making visible, systematizing and refining the doctor's tacit conversational skills, the clinical method represents a model for transforming individual clinical experiences into medical knowledge. Premises for generalization of the method towards clinical problems beyond women's "undefined" disorders are discussed.

authors

Malterud K

doi

10.3109/02813439409003686

subject

Has Abstract

pub_date

1994-06-01 00:00:00

pages

121-7

issue

2

eissn

0281-3432

issn

1502-7724

journal_volume

12

pub_type

杂志文章,评审
  • Plasma albumin and calcium concentrations, and long-term mortality in primary health care patients in Sweden.

    abstract:OBJECTIVE:Low plasma (p)-albumin and p-calcium concentrations are associated with increased mortality in hospitalised patients. There are few studies addressing this in primary care. Low p-calcium has been associated with mortality, but it is not known whether this applies to p-albumin. Could p-albumin and p-calcium be...

    journal_title:Scandinavian journal of primary health care

    pub_type: 杂志文章

    doi:10.1080/02813432.2020.1843809

    authors: Dalemo S,Boström KB,Hjerpe P

    更新日期:2020-12-01 00:00:00

  • Myocardial infarction risk factors in a semirural area in mid-Sweden. The population study "50-year-old people in Kungsör".

    abstract::The mortality from ischaemic heart disease is higher in predominantly rural northern and western Sweden than in the more urban eastern and southern districts. This study was performed in a small semirural area in mid-Sweden with lower mortality from ischaemic heart disease in middle-aged men and higher mortality in mi...

    journal_title:Scandinavian journal of primary health care

    pub_type: 杂志文章

    doi:10.3109/02813439109018515

    authors: Thorell B,Svärdsudd K

    更新日期:1991-09-01 00:00:00

  • Diagnostic work in general practice: more than naming a disease.

    abstract:OBJECTIVE:To explore the medically unexplained disorders by examining endpoints of irresolute diagnostic strategies. DESIGN:Qualitative observational study based on audio-taped general practice consultations, editing analysis style inspired by Giorgi's phenomenological approach. SETTING:Primary health care. SUBJECTS...

    journal_title:Scandinavian journal of primary health care

    pub_type: 杂志文章

    doi:10.1080/028134302760234582

    authors: Undeland M,Malterud K

    更新日期:2002-09-01 00:00:00

  • Variations in older people's use of general practitioner consultations and the relationship with mortality rate in Vantaa, Finland in 2003-2014.

    abstract::Objective: It is generally expected that the growth of the older population will lead to an increase in the use of health care services. The aim was to examine the changes in the number of visits made to general practitioners (GP) by the older age groups, and whether such changes were associated with changes in mortal...

    journal_title:Scandinavian journal of primary health care

    pub_type: 杂志文章

    doi:10.1080/02813432.2019.1684426

    authors: Mustonen K,Kauppila T,Rahkonen O,Kantonen J,Raina M,Mäki T,Pitkälä K

    更新日期:2019-12-01 00:00:00

  • Impaired health status, and mental health, lower vitality and social functioning in women general practitioners in Sweden. A cross-sectional survey.

    abstract:OBJECTIVE:The aim was to analyse differences between female and male general practitioners (GPs) in health status and lifestyle and compared with the general population in health-related quality of life. DESIGN:A simple random sample of 1004 GPs from the whole of Sweden (71.2%) participated in a survey in May 1996 abo...

    journal_title:Scandinavian journal of primary health care

    pub_type: 杂志文章

    doi:10.1080/028134399750002692

    authors: Sundquist J,Johansson SE

    更新日期:1999-06-01 00:00:00

  • Colonization with potentially pathogenic respiratory tract bacteria. A household study.

    abstract::A group of 235 persons (180 adults and 55 children 0-15 years old) recorded symptoms of upper respiratory tract infection daily during two three-month periods (autumn 1986 and spring 1987). Samples for culture were taken from the nasopharynx and throat once during each period. Fifteen per cent of asymptomatic subjects...

    journal_title:Scandinavian journal of primary health care

    pub_type: 杂志文章

    doi:10.3109/02813438909088665

    authors: Schwan A,Eriksson M,Eriksson BM,Carlson U,Petterson E,Sandblom M,Tibblin G

    更新日期:1989-12-01 00:00:00

  • Usefulness of natriuretic peptides in primary health care: an exploratory study in elderly patients.

    abstract:OBJECTIVE:To explore the negative predictive value (NPV), positive predictive value (PPV), sensitivity, and specificity of natriuretic peptides, cut-off levels, and the impact of gender and age in elderly patients with systolic heart failure (HF). DESIGN:Cross-sectional exploratory study. SETTING:One primary healthca...

    journal_title:Scandinavian journal of primary health care

    pub_type: 杂志文章

    doi:10.3109/02813430903345074

    authors: Olofsson M,Boman K

    更新日期:2010-03-01 00:00:00

  • Yoga - a laborious way to well-being: patients' experiences of yoga as a treatment for hypertension in primary care.

    abstract:OBJECTIVE:The aim of the study was to describe patients' experience of yoga as a treatment for hypertension, as well as their experience of living with hypertension. DESIGN:Qualitative interview study Method and materials: In 2013-2014, in southern Sweden, patients with hypertension from three health care centres were...

    journal_title:Scandinavian journal of primary health care

    pub_type: 杂志文章

    doi:10.1080/02813432.2017.1397318

    authors: Wolff M,Brorsson A,Midlöv P,Sundquist K,Strandberg EL

    更新日期:2017-12-01 00:00:00

  • Reasons for encounter and disease patterns in Danish primary care: changes over 16 years.

    abstract:OBJECTIVE:Approximately 98% of Danish citizens are listed with a general practice which they consult for medical advice. Although 85% of the population contact their general practitioner (GP) every year, little is known about these contacts. The aim of the present paper is to gain updated knowledge about patients' reas...

    journal_title:Scandinavian journal of primary health care

    pub_type: 杂志文章

    doi:10.3109/02813432.2012.679230

    authors: Moth G,Olesen F,Vedsted P

    更新日期:2012-06-01 00:00:00

  • Variation in use of penicillin for treatment of sinusitis in general practice.

    abstract::The present study describes the use of phenoxymethylpenicillin and broad-spectrum penicillin for the treatment of sinusitis in general practice, in relation to some variables related to the prescribing doctors: region (county), practice form (single-handed or partnership), and the doctors' seniority (year of graduatio...

    journal_title:Scandinavian journal of primary health care

    pub_type: 杂志文章

    doi:10.3109/02813438809009312

    authors: Bro F,Mabeck CE

    更新日期:1988-09-01 00:00:00

  • Improving health centre physicians' child-psychiatric networks.

    abstract:OBJECTIVE:To study changes in Finnish GPs' child-psychiatric networks over a one-year period. DESIGN:Postal questionnaire. SETTING:Health centres in the area of Tampere University Hospital with a catchment population of one million. INTERVENTION:A one-off course in the field of child psychiatry was held 56 times in ...

    journal_title:Scandinavian journal of primary health care

    pub_type: 杂志文章

    doi:10.1080/02813430510018374

    authors: Heikkinen A,Puura K,Mattila K

    更新日期:2005-03-01 00:00:00

  • Clinical and bacteriological outcome of different doses and duration of pivmecillinam compared with placebo therapy of uncomplicated lower urinary tract infection in women: the LUTIW project.

    abstract:OBJECTIVE:To analyse associations between symptoms and bacteriuria in uncomplicated lower urinary tract infection in women (LUTIW) and to evaluate outcome of therapy with three different regimens of pivmecillinam or placebo. DESIGN:Prospective, multicentre, randomized, double-blind, and placebo-controlled therapy stud...

    journal_title:Scandinavian journal of primary health care

    pub_type: 杂志文章,多中心研究,随机对照试验

    doi:10.1080/02813430601183074

    authors: Ferry SA,Holm SE,Stenlund H,Lundholm R,Monsen TJ

    更新日期:2007-03-01 00:00:00

  • Awareness and treatment of cardiovascular disease risk factors among middle-aged Swedish men and women.

    abstract:OBJECTIVE:To study awareness and treatment of risk factors for cardiovascular disease in a primary care district where a screening program for hypercholesterolaemia involving one third of the population had been conducted 7 years earlier. DESIGN:A semi-structured telephone survey on four risk factors; blood pressure, ...

    journal_title:Scandinavian journal of primary health care

    pub_type: 杂志文章

    doi:10.1080/028134398750003124

    authors: Ovhed I,Odeberg H,Troein M,Råstam L

    更新日期:1998-09-01 00:00:00

  • Determinants of adherence to recommendations for depressed elderly patients in primary care: a multi-methods study.

    abstract:OBJECTIVE:It is logical that tailoring implementation strategies to address identified determinants of adherence to clinical practice guidelines should improve adherence. This study aimed to identify and prioritize determinants of adherence to six recommendations for elderly patients with depression. DESIGN AND SETTIN...

    journal_title:Scandinavian journal of primary health care

    pub_type: 杂志文章

    doi:10.3109/02813432.2014.984961

    authors: Aakhus E,Oxman AD,Flottorp SA

    更新日期:2014-12-01 00:00:00

  • Visit patterns at primary care centres and individual blood pressure level - a cross-sectional study.

    abstract:OBJECTIVE:Hypertension is a major cause of cardiovascular disease. Nevertheless, blood pressure (BP) is often inadequately treated. We studied visit patterns at primary health care centres (PHCCs) and their relation to individual BP control. DESIGN AND SETTING:Cross-sectional register-based study on all patients with ...

    journal_title:Scandinavian journal of primary health care

    pub_type: 杂志文章

    doi:10.1080/02813432.2019.1569369

    authors: Ödesjö H,Adamsson Eryd S,Franzén S,Hjerpe P,Manhem K,Rosengren A,Thorn J,Björck S

    更新日期:2019-03-01 00:00:00

  • Out-of-hours service in rural areas. An observational study of accessibility, attitudes and quality standards among general practitioners in Iceland.

    abstract:OBJECTIVES:To examine the access, workload, duties, commitments and quality standards of primary care physicians (GPs) resulting from out-of-hours service. SETTING:All GPs (n = 96) in rural Iceland. MAIN OUTCOME MEASURES:Answers to a postal survey. RESULTS:The participation rate was 80%. The GPs estimated that in 97...

    journal_title:Scandinavian journal of primary health care

    pub_type: 杂志文章

    doi:10.1080/028134300750018945

    authors: Olafsson G,Sigurdsson JA

    更新日期:2000-06-01 00:00:00

  • Urinary tract infection in primary health care in northern Sweden. II. Clinical presentation.

    abstract::In a multipractice prevalence study of uncomplicated urinary tract infection (UTI) in primary health care (PHC), with 355 episodes in 302 individuals during one month, 93% of the episodes occurred in females and Escherichia coli was the dominating causative organism (77%). Most episodes of UTI (84%) were acute and ass...

    journal_title:Scandinavian journal of primary health care

    pub_type: 杂志文章

    doi:10.3109/02813438709014000

    authors: Ferry S,Burman LG,Mattsson B

    更新日期:1987-09-01 00:00:00

  • The association between patient shortage and patient satisfaction with general practitioners.

    abstract:OBJECTIVE:The aim of the study was to explore whether or not the influx of patients to a GP's practice is associated with satisfaction with the GP. DESIGN:Persons in the Norwegian Living Condition Survey answered a questionnaire on satisfaction with their GP. The data on satisfaction were merged with registered inform...

    journal_title:Scandinavian journal of primary health care

    pub_type: 杂志文章

    doi:10.1080/02813430701286579

    authors: Lurås H

    更新日期:2007-09-01 00:00:00

  • What do patients want and not want to see about themselves on the computer screen: a qualitative study.

    abstract:OBJECTIVE:To explore patients' views about what they would or would not like to read on the computer screen, and how this might be managed. DESIGN:A qualitative study using semi-structured interviews with patients who had recently consulted, and who were representative of the age-sex structure of our practice populati...

    journal_title:Scandinavian journal of primary health care

    pub_type: 杂志文章

    doi:10.3109/02813439709035024

    authors: Ridsdale L,Hudd S

    更新日期:1997-12-01 00:00:00

  • Factors related to consultation time: experience in Slovenia.

    abstract:OBJECTIVE:Consultation time has a serious impact on physicians' work and patient satisfaction. No systematic study of consultation time in general practice in Slovenia has yet been carried out. The aim of the present study was to measure consultation time, to identify the factors influencing it, and to study the influe...

    journal_title:Scandinavian journal of primary health care

    pub_type: 杂志文章

    doi:10.1080/02813430701760789

    authors: Petek Ster M,Svab I,Zivcec Kalan G

    更新日期:2008-01-01 00:00:00

  • Wound management for 287 patients with chronic leg ulcers demands 12 full-time nurses. Leg ulcer epidemiology and care in a well-defined population in southern Sweden.

    abstract:OBJECTIVE:To study the prevalence, aetiology and treatment of chronic leg and foot ulcers, and to estimate the nurse's time in wound management. DESIGN:A structured questionnaire with 19 questions about chronic ulcers and wound management was sent to all district and community nurses in the county during 1 week in Mar...

    journal_title:Scandinavian journal of primary health care

    pub_type: 杂志文章,多中心研究

    doi:10.1080/028134300448788

    authors: Oien RF,Håkansson A,Ovhed I,Hansen BU

    更新日期:2000-12-01 00:00:00

  • Events leading to the decision to introduce complementary feeding to the breast among a group of mothers in Istanbul.

    abstract::A cross-sectional study carried out among 269 mother-infant pairs in Istanbul showed that the majority of infants began receiving regular complements or had been weaned before the age of three months. A prospective study carried out among 24 mothers beginning the last month of pregnancy and continuing until the time w...

    journal_title:Scandinavian journal of primary health care

    pub_type: 杂志文章

    doi:10.3109/02813438609014837

    authors: Kocturk TO

    更新日期:1986-11-01 00:00:00

  • Concordance between elderly patients' understanding of and their primary healthcare physician's diagnosis of heart failure.

    abstract:OBJECTIVE:The objective was to study primary healthcare patients' understanding of their diagnosis of heart failure (HF), using patients treated for diabetes mellitus (DM) as a comparative group. DESIGN:A cross-sectional community based study. SETTING:Karlskrona community situated on the Swedish south-east coast with...

    journal_title:Scandinavian journal of primary health care

    pub_type: 杂志文章

    doi:10.1080/02813430500428919

    authors: Halling A,Berglund J

    更新日期:2006-06-01 00:00:00

  • Infectious diseases in Greenlanders of Upernavik.

    abstract::During one year, 1979-80, all the contacts between the 836 inhabitants of Upernavik town and the local medical officers were recorded. In the 737 native Greenlanders 1006 contacts (41%) were caused by infectious diseases, representing 705 episodes of disease. The number of contacts per episode of disease was similar i...

    journal_title:Scandinavian journal of primary health care

    pub_type: 杂志文章

    doi:10.3109/02813438509013939

    authors: Bjerregaard P

    更新日期:1985-09-01 00:00:00

  • Predictors for spread of clinical group A streptococcal tonsillitis within the household.

    abstract:OBJECTIVE:The objectives of this study were to explore how frequently group A streptococci (GAS) were giving additional cases of clinical GAS tonsillitis within the households and to analyse predictors for such spread of GAS infection. SETTING:Two Norwegian general practice populations in Stokke and Kongsberg communit...

    journal_title:Scandinavian journal of primary health care

    pub_type: 杂志文章

    doi:10.1080/02813430410006729

    authors: Lindbaek M,Høiby EA,Lermark G,Steinsholt IM,Hjortdahl P

    更新日期:2004-12-01 00:00:00

  • Genetic consultations in primary care: GPs' responses to three scenarios.

    abstract:OBJECTIVE:This study investigated general practitioners' responses to three scenarios in which patients consulted regarding genetic conditions. DESIGN:Self-completed postal study. Setting. Primary care in Northern Ireland. SUBJECTS:Questionnaire were distributed to all the GPs in Northern Ireland (n = 1079). A total ...

    journal_title:Scandinavian journal of primary health care

    pub_type: 杂志文章

    doi:10.1080/02813430510015259

    authors: McCann S,MacAuley D,Barnett Y

    更新日期:2005-06-01 00:00:00

  • Factors associated with self-rated health in primary care.

    abstract:BACKGROUND:Self-rated health (SRH) measures one's current general health and is a widely used health indicator. Sleep problems, somatic health complaints, and unmet needs in interpersonal relationships are suspected to influence SRH, but studies in primary health care settings are sparse. OBJECTIVE:To examine the asso...

    journal_title:Scandinavian journal of primary health care

    pub_type: 杂志文章

    doi:10.1080/02813432.2018.1499590

    authors: Mildestvedt T,Herikstad VV,Undheim I,Bjorvatn B,Meland E

    更新日期:2018-09-01 00:00:00

  • The added value of the registration of home accidents in general practice.

    abstract:OBJECTIVES:To determine the number, the nature and the circumstances of home accidents managed in general practices, and to compare the results with the European Home and Leisure Accidents Surveillance System (EHLASS) data. DESIGN:A prospective population survey of all domestic accidents managed in 138 sentinel genera...

    journal_title:Scandinavian journal of primary health care

    pub_type: 杂志文章

    doi:

    authors: Devroey D,Van Casteren V,Walckiers D

    更新日期:2002-06-01 00:00:00

  • Clinical assessment of pharyngitis in general practice.

    abstract::The present study investigates the feasibility of the clinical differentiation between patients with beta-haemolytic streptococcal pharyngitis from those with pharyngitis caused by other agents, based on the patients' symptoms, symptom duration, and the clinical findings. Twenty-four general practitioners recruited 22...

    journal_title:Scandinavian journal of primary health care

    pub_type: 杂志文章

    doi:10.3109/02813438809009320

    authors: Hjortdahl P,Laerum E,Mowinckel P

    更新日期:1988-11-01 00:00:00

  • Sputum colour for diagnosis of a bacterial infection in patients with acute cough.

    abstract:OBJECTIVE:Sputum colour plays an important role in the disease concepts for acute cough, both in the patients' and the doctors' view. However, it is unclear whether the sputum colour can be used for diagnosis of a bacterial infection. DESIGN:Cross-sectional study. SETTING:A total of 42 GP practices in Dusseldorf, Ger...

    journal_title:Scandinavian journal of primary health care

    pub_type: 杂志文章

    doi:10.1080/02813430902759663

    authors: Altiner A,Wilm S,Däubener W,Bormann C,Pentzek M,Abholz HH,Scherer M

    更新日期:2009-01-01 00:00:00