Qualitative study of interpretation of reassurance among patients attending rheumatology clinics: "just a touch of arthritis, doctor?"

Objectives To examine commonly used methods of reassurance by clinicians an d explore their effect on patients. Design Qualitative study of tape recordings of in-depth, semistructured int erviews with patients before and after consultation and of their consultati ons with doctors. Setting NHS specialist rheumatology clinics in two large British cities. Participants 35 patients selected by consultant rheumatologists from genera l practitioner referral letters (28 women, 7 men; 24 with inflammatory arth ropathies, ii other rheumatological complaints). Main outcome measures Patients' perceptions of reassurance. Results Reassurance was an important part of consultations, whether the dia gnosis was clear or uncertain. Clinicians tried to reduce anxiety by emphas ising the mildness, early stage, or non-seriousness of the disorder and the likelihood that patients would recover. Patients interpreted reassurance i n the context of their own views and perceptions. Doctors' emphasis on the mildness or earliness of the condition raised the spectre of future pain an d disability rather than providing reassurance. Patients who felt;hat their problems were properly acknowledged felt more reassured. Conclusions Typical patterns of reassurance were not successful because of the differences in perspective of patients and doctors. A key to successful reassurance seemed to be the doctor's ability to acknowledge patients' per spectives of their difficulties.