Missing the meaning & provoking resistance; a case of ME

BACKGROUND. The interaction between a clinician and a patient

who put his problems down to myalgic encephalomyelitis is

described. Despite attempting a patient-centred approach, the

doctor acted on his own understanding of the meaning of this

diagnosis without gaining proper insight into what it meant

for the patient. This failure not only led to damaged rapport,

it may have contributed to delayed recovery.


unsatisfactory nature of this encounter led the clinician to

consider more effective consulting techniques.


RESULTS. A hypothetical interaction is constructed in which

the clinician uses reflective listening statements to

understand the patient’s true meaning of this self-diagnosis.

CONCLUSIONS. Despite well intentioned attempts to be

patient-centered through widening the consultation beyond the

biomedical to include personal and contextual factors,

clinicians may still end up imposing their own medical meaning

on patient’s words. Damaged rapport is a signal that another

track could be more fruitful and reflective listening is one

strategy which enables clinicians to check that they fully

understand the patient’s meaning. Provoking resistance by

following strategies which are not appropriate for the patient

might then be avoided.

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