IDEAS home Printed from https://ideas.repec.org/a/eee/socmed/v298y2022ics027795362200168x.html
   My bibliography  Save this article

Negotiating ‘the problem’ in GP home visits to people with dementia

Author

Listed:
  • Dooley, Jemima
  • Barnes, Dr Rebecca

Abstract

People with dementia are often marginalised in health care due to the effects of the condition on short term memory and communication. The problem presentation is a key area of primary care consultations where patients ‘have the floor’, and hence are able to direct the trajectory of the consultation to achieve certain ends. An exploration of how patients with advanced dementia participate in this stage of the consultation can thus demonstrate their participation and subsequent engagement. We used conversation analysis to describe how healthcare professionals (HCPs), people with dementia, and their carers establish the presenting problem in 17 out-of-hours primary care home visit consultations. In all cases, the carer had called the out of hours service on behalf of the patient. Rather than traditional “what can I help you with?” problem solicits, HCPs instead stated their reason-for-visit using information provided by the carer. All the patients showed some misalignment with this presented reason-for-visit, by denying the existence of current symptoms and/or their involvement in the decision to call the doctor. Carers appeared to show respect for the patient's ownership of their experience, only providing input on invitation from doctors or patients. Patient acknowledgement and willingness to engage in examination were needed for progressivity, but agreement with the reason-for-visit was not. In two consultations, the reason-for-visit was not explained to patients, and in both cases this resulted in the person with dementia showing frustration and resistance to examination. People with dementia may resist doctor home visits for many reasons, such as embarrassment for not remembering symptoms, or stoicism in the face of medical ailments. These findings show how the balance of progressivity and intersubjectivity tips towards progressivity in consultations with people with dementia, but this is reversed when the patient is not engaged in the reason-for-visit.

Suggested Citation

  • Dooley, Jemima & Barnes, Dr Rebecca, 2022. "Negotiating ‘the problem’ in GP home visits to people with dementia," Social Science & Medicine, Elsevier, vol. 298(C).
    • Handle: RePEc:eee:socmed:v:298:y:2022:i:c:s027795362200168x
    DOI: 10.1016/j.socscimed.2022.114862
    as

    Download full text from publisher

    File URL: http://www.sciencedirect.com/science/article/pii/S027795362200168X
    Download Restriction: Full text for ScienceDirect subscribers only
    File URL: https://libkey.io/10.1016/j.socscimed.2022.114862?utm_source=ideas
    LibKey link: if access is restricted and if your library uses this service, LibKey will redirect you to where you can use your library subscription to access this item
    ---><---

    As the access to this document is restricted, you may want to search for a different version of it.

    References listed on IDEAS

    as
    1. O'Brien, Rebecca & Beeke, Suzanne & Pilnick, Alison & Goldberg, Sarah E & Harwood, Rowan H, 2020. "When people living with dementia say ‘no’: Negotiating refusal in the acute hospital setting," Social Science & Medicine, Elsevier, vol. 263(C).
    2. Robinson, Jeffrey D. & Heritage, John, 2005. "The structure of patients' presenting concerns: the completion relevance of current symptoms," Social Science & Medicine, Elsevier, vol. 61(2), pages 481-493, July.
    3. Heritage, John & Stivers, Tanya, 1999. "Online commentary in acute medical visits: a method of shaping patient expectations," Social Science & Medicine, Elsevier, vol. 49(11), pages 1501-1517, December.
    4. Christiane Pinkert & Eva Faul & Susi Saxer & Melanie Burgstaller & Doris Kamleitner & Hanna Mayer, 2018. "Experiences of nurses with the care of patients with dementia in acute hospitals: A secondary analysis," Journal of Clinical Nursing, John Wiley & Sons, vol. 27(1-2), pages 162-172, January.
    Full references (including those not matched with items on IDEAS)

    Most related items

    These are the items that most often cite the same works as this one and are cited by the same works as this one.
    1. Chatwin, John & Kennedy, Anne & Firth, Adam & Povey, Andrew & Rogers, Anne & Sanders, Caroline, 2014. "How potentially serious symptom changes are talked about and managed in COPD clinical review consultations: A micro-analysis," Social Science & Medicine, Elsevier, vol. 113(C), pages 120-136.
    2. Montenegro, Roberto E. & Dori-Hacohen, Gonen, 2020. "Morality in sugar talk: Presenting blood glucose levels in routine diabetes medical visits," Social Science & Medicine, Elsevier, vol. 253(C).
    3. Tate, Alexandra, 2020. "Invoking death: How oncologists discuss a deadly outcome," Social Science & Medicine, Elsevier, vol. 246(C).
    4. Heritage, John & McArthur, Amanda, 2019. "The diagnostic moment: A study in US primary care," Social Science & Medicine, Elsevier, vol. 228(C), pages 262-271.
    5. Benwell, Bethan & Rhys, Catrin S., 2018. "Negotiating relevance in pre-operative assessments," Social Science & Medicine, Elsevier, vol. 200(C), pages 218-226.
    6. Stefanie Lopriore & Amanda LeCouteur & Katie Ekberg & Stuart Ekberg, 2019. "“You'll have to be my eyes and ears”: A conversation analytic study of physical examination on a health helpline," Journal of Clinical Nursing, John Wiley & Sons, vol. 28(1-2), pages 330-339, January.
    7. Gibson, Mark & Neil Jenkings, K. & Wilson, Rob & Purves, Ian, 2006. "Verbal prescribing in general practice consultations," Social Science & Medicine, Elsevier, vol. 63(6), pages 1684-1698, September.
    8. Zhang, Xi & Wei, Xin & Zhang, Te & Tan, Yahe & Xu, Dongming & Ordóñez de Pablos, Patricia, 2023. "How platform-based internet hospital innovation affects doctors’ active stress coping efforts: The conservation of resource theory perspective," Technovation, Elsevier, vol. 121(C).
    9. Turowetz, Jason, 2022. "Interaction order and the labeling of disorder: How parents mobilize personal knowledge in the clinic to resist medicalization of their children's behavior," Social Science & Medicine, Elsevier, vol. 294(C).
    10. Pilnick, Alison & O'Brien, Rebecca & Beeke, Suzanne & Goldberg, Sarah & Harwood, Rowan, 2021. "Avoiding repair, maintaining face: Responding to hard-to-interpret talk from people living with dementia in the acute hospital," Social Science & Medicine, Elsevier, vol. 282(C).
    11. Stivers, Tanya & Timmermans, Stefan, 2021. "Arriving at no: Patient pressure to prescribe antibiotics and physicians’ responses," Social Science & Medicine, Elsevier, vol. 290(C).
    12. Younhee Kang & Yujin Hur, 2021. "Nurses’ Experience of Nursing Workload-Related Issues during Caring Patients with Dementia: A Qualitative Meta-Synthesis," IJERPH, MDPI, vol. 18(19), pages 1-12, October.
    13. White, Anne Elizabeth Clark, 2020. "When and how do surgeons initiate noticings of additional concerns?," Social Science & Medicine, Elsevier, vol. 244(C).
    14. Bridges, Susan & Drew, Paul & Zayts, Olga & McGrath, Colman & Yiu, Cynthia K.Y. & Wong, H.M. & Au, T.K.F., 2015. "Interpreter-mediated dentistry," Social Science & Medicine, Elsevier, vol. 132(C), pages 197-207.
    15. Zhang, Shuai & Cheng, Meili & Ma, Wen & Liu, Huashui & Zhao, Chunjuan, 2023. "Companion responses to diagnosis in Chinese outpatient clinical interaction," Social Science & Medicine, Elsevier, vol. 338(C).
    16. Lindström, Anna K.B. & Tängdén, Thomas, 2022. "Introducing the C-reactive protein point-of-care test: A conversation analytic study of primary care consultations for respiratory tract infection," Social Science & Medicine, Elsevier, vol. 315(C).
    17. Maynard, Douglas W., 2006. ""Does it mean I'm gonna die?": On meaning assessment in the delivery of diagnostic news," Social Science & Medicine, Elsevier, vol. 62(8), pages 1902-1916, April.
    18. Broom, Alex & Broom, Jennifer & Kirby, Emma, 2014. "Cultures of resistance? A Bourdieusian analysis of doctors' antibiotic prescribing," Social Science & Medicine, Elsevier, vol. 110(C), pages 81-88.
    19. Sterponi, Laura & Zucchermaglio, Cristina & Fatigante, Marilena & Alby, Francesca, 2019. "Structuring times and activities in the oncology visit," Social Science & Medicine, Elsevier, vol. 228(C), pages 211-222.
    20. Wei, Wan, 2024. "Beyond the patient-doctor dyad: Examining “other” patient engagement in Traditional Chinese Medicine consultations," Social Science & Medicine, Elsevier, vol. 340(C).

    Corrections

    All material on this site has been provided by the respective publishers and authors. You can help correct errors and omissions. When requesting a correction, please mention this item's handle: RePEc:eee:socmed:v:298:y:2022:i:c:s027795362200168x. See general information about how to correct material in RePEc.

    If you have authored this item and are not yet registered with RePEc, we encourage you to do it here. This allows to link your profile to this item. It also allows you to accept potential citations to this item that we are uncertain about.

    If CitEc recognized a bibliographic reference but did not link an item in RePEc to it, you can help with this form .

    If you know of missing items citing this one, you can help us creating those links by adding the relevant references in the same way as above, for each refering item. If you are a registered author of this item, you may also want to check the "citations" tab in your RePEc Author Service profile, as there may be some citations waiting for confirmation.

    For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: Catherine Liu (email available below). General contact details of provider: http://www.elsevier.com/wps/find/journaldescription.cws_home/315/description#description .

    Please note that corrections may take a couple of weeks to filter through the various RePEc services.

    IDEAS is a RePEc service. RePEc uses bibliographic data supplied by the respective publishers.