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

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  • 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
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    References listed on IDEAS

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    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.
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