Patient Involvement in Problem Presentation and Diagnosis Delivery in Primary Care

Abstract

This article examines how physicians orient to their patients’ problem presentations both in receiving it and in the diagnostic phase in primary care encounters. Four types of patients’ problem presentation are discussed: 1) symptoms only, 2) candidate diagnosis 3) diagnosis implicative symptom description and 4) candidate diagnosis as background information. Both in receiving the problem and in diagnosis delivery, doctors address the patients’ problem presentations in cases where the presentation involved or implied a candidate diagnosis, whereas with ‘symptoms only’ –type of problem presentation such references predominantly are not made. In terms of patient participation, the study suggests that a patient’s problem presentation has a crucial role in shaping the doctors’ communication patterns also in the phases of consultation in which the patient’s active participation is of lesser role, such as the diagnostic phase. The data used in this study consist of 86 Finnish primary care visits with adult and child patients suffering from an upper respiratory tract infection. The method of the study is conversation analysis.