Epistemological and methodological paradoxes: secondary care specialists and their challenges working with adolescents with medically unexplained symptoms
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Epistemological and methodological paradoxes : secondary care specialists and their challenges working with adolescents with medically unexplained symptoms. / Østbye, Silje Vagli; Wang, Catharina Elisabeth Arfwedson; Granheim, Ida Pauline Høilo; Kristensen, Kjersti Elisabeth; Risør, Mette Bech.
In: International Journal of Mental Health Systems, Vol. 12, 2018.Research output: Contribution to journal › Journal article › Research › peer-review
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TY - JOUR
T1 - Epistemological and methodological paradoxes
T2 - secondary care specialists and their challenges working with adolescents with medically unexplained symptoms
AU - Østbye, Silje Vagli
AU - Wang, Catharina Elisabeth Arfwedson
AU - Granheim, Ida Pauline Høilo
AU - Kristensen, Kjersti Elisabeth
AU - Risør, Mette Bech
PY - 2018
Y1 - 2018
N2 - Background: Early adolescence is considered a critical period for the development of chronic and recurrent medically unexplained symptoms (MUS), and referrals and system-initiated patient trajectories often lead to an excess of examinations and hospitalizations in the cross-section between mental and somatic specialist care for this group of patients. Dimensions of the relationship and communication between clinician and patient are shown in primary care studies to be decisive for subsequent illness pathways, often creating adverse effects, but knowledge on clinical communication in specialist care is still scarce.Methods: This study explores communicative challenges specific to clinical encounters between health professionals and adolescent patients in specialist care, as presented through interviews and focus group data with highly experienced specialists working in adolescent and child services at a Norwegian university hospital.Results: The results are presented in a conceptual model describing the epistemological and methodological paradoxes inherent in the clinical uncertainty of MUS. Within these paradoxes, the professionals try to solve the dilemmas by being creative in their communication strategies; applying metaphors and other rhetorical devices to explain complex ideas; creating clinical prototypes as a way to explain symptoms and guide them in clinical action; relying on principles from patient-centered care involving empathy; and trying to balance expertise and humility.Conclusion: The challenges in communication arise as a result of opposing discourses on biomedicine, family, health and adolescence that create dilemmas in everyday clinical work. By moving away from a positivist and biomedical framework towards an interpretive paradigm, where culturally derived and historically situated interpretations are used to understand the social life-world of the patient, one can create a more humane health service in accordance with ideals of patient-centered care.
AB - Background: Early adolescence is considered a critical period for the development of chronic and recurrent medically unexplained symptoms (MUS), and referrals and system-initiated patient trajectories often lead to an excess of examinations and hospitalizations in the cross-section between mental and somatic specialist care for this group of patients. Dimensions of the relationship and communication between clinician and patient are shown in primary care studies to be decisive for subsequent illness pathways, often creating adverse effects, but knowledge on clinical communication in specialist care is still scarce.Methods: This study explores communicative challenges specific to clinical encounters between health professionals and adolescent patients in specialist care, as presented through interviews and focus group data with highly experienced specialists working in adolescent and child services at a Norwegian university hospital.Results: The results are presented in a conceptual model describing the epistemological and methodological paradoxes inherent in the clinical uncertainty of MUS. Within these paradoxes, the professionals try to solve the dilemmas by being creative in their communication strategies; applying metaphors and other rhetorical devices to explain complex ideas; creating clinical prototypes as a way to explain symptoms and guide them in clinical action; relying on principles from patient-centered care involving empathy; and trying to balance expertise and humility.Conclusion: The challenges in communication arise as a result of opposing discourses on biomedicine, family, health and adolescence that create dilemmas in everyday clinical work. By moving away from a positivist and biomedical framework towards an interpretive paradigm, where culturally derived and historically situated interpretations are used to understand the social life-world of the patient, one can create a more humane health service in accordance with ideals of patient-centered care.
U2 - 10.1186/s13033-018-0232-0
DO - 10.1186/s13033-018-0232-0
M3 - Journal article
C2 - 30258491
VL - 12
JO - International Journal of Mental Health Systems
JF - International Journal of Mental Health Systems
SN - 1752-4458
ER -
ID: 278486986