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Electronic letters published:
![[Read Comment]](/icons/misc/sectionDOWN.gif){kind=icon}
More talk, less action
Qualitative research provides the color in our guidelines
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Christopher F Dowrick, Liverpool, UK Professor of Primary Medical Care
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Karasz and Watkins describe how Hispanic patients value the advice and guidance given by their doctors, over and above any specific actions they perform with regard to prescribing or referral. This is important. Primary health care is increasingly becoming a technological discipline, and both doctors and patients benefits in many ways as a result. But we should not forget - or devalue - the instrinsic worth of the clinical encounter itself. What we try to do in our encounters with patients whom we think may be depressed, is to help them find some meaning and purpose out of seemingly undifferentiated suffering and distress (1). This is perhaps the essence of healing, a word which has fallen into disuse and disrepute in modern medicine. At the heart of the process lie two assumptions: that the emergence of meaning, order or form is therapeutic in itself, particularly for people who are feeling lost, alone, frightened or misunderstood (2); and that such emergence is most effective if it is mutual, if understanding of problems and their solutions are negotiated and agreed by both sides. I think that, as primary care physicians, we often fail to recognise our own ability to help our distressed patients generate new meanings. It is good to find evidence that our patients do value what we say to them, not just what we do. (1) Dowrick C. Beyond Depression. Oxford, Oxford University Press, 2004. (2) Gask L, Rogers A, Oliver D, May C, Roland M. Qualitative study of patients' perceptions of the quality of care in general practice. Br J Gen Pract 2003;53:278-83 Competing interests: None declared |
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Patricia Adam, Minneapolis, MN Family Physician faculty at the University of Minnesota
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Qualitative research provides the color in the black and white world of guidelines. We are all aware of the guidelines recommending agressive medical management of depression, but are at a loss when our patients aren't partners in that management. Dr.s Karasz and Watkins careful work validates what many of us sense, that connecting with our patients by simply listening and giving advice, may be an important step in cementing that therapeutic relationship. I'd like to see this area of research expand. What about those who did not find physicians helpful? What underlies their perception that we cannot help them? By exploring these barriers and addressing them, may we improve depression care? How do we translate that knowledge into practice? As always, in research, the more questions we explore, the more questions we raise. Competing interests: None declared |
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