Patients' stories: science, clinical facts or fairy tales?

OBJECTIVE: To explore potentials and attributes of the qualitative research interview as a tool for acquiring knowledge about illness. DESIGN: A qualitative approach, comparing knowledge about consultations originating from 1) data from interviews with immigrant female patients, and 2) evaluative data from registration forms from the doctors. SETTING AND SUBJECTS: 24 Pakistani female patients, recruited from the appointment list at a primary health care centre in central Oslo were interviewed in their homes. Evaluation forms were filled in by the ten physicians consulted. MAIN OUTCOME MEASURES: Illness knowledge derived from different communicative contexts. Contextual prerequisites suggest potential roads to the inquiry of illness applicable in the clinical context. CASE STORIES: Patients' illness perspectives and resources were probably encouraged in the interview by means of discourse underlining the women's resources. This position may have emerged because the women were actually consulted by the interviewer. Dialogues actively seeking out the other person's illness perspective, as recommended in the qualitative interview, seem to encourage adequate exchange of medical information. CONCLUSION/IMPLICATIONS: Pursuing and modifying strategies from the qualitative interview for exploration of illness may contribute to clinical facts as well as scientific knowledge concerning illness.

[Norwegian and immigrant patients at a health care center. Are there real differences?]. / Norske pasienter og innvandrerpasienter ved et legesenter. Er det virkelig forskjeller?

Routine data from a Primary Health Care Centre in Oslo have been analysed to find differences between Norwegian and immigrant patients. We compared frequencies of diagnoses, as well as pattern and outcome of contacts (laboratory-tests, referrals and follow-up appointments). The two patient groups showed different age and gender distribution. There were fewer children, more elderly and more women among the Norwegians than among the immigrants. This explains the differences in the pattern of contact, and its outcome. Differences in the distribution of diagnoses also depended on group related factors other than the unequal age and gender distribution. The higher frequency of non-specific conditions among immigrants and mental diseases among Norwegians were due to group-specific factors alone. The first of these differences is interpreted as a sign of poor communication between the doctor and the immigrant patients. More seldom than expected, the differences were related to other factors than age and gender distribution. It is therefore important to focus also on similarities when comparing native and immigrant patients.