On patient judgement

Clinical judgement, the keystone of medical expertise, is a hot topic. By c ontrast, patient judgement, also of central importance in health care, rece ives little attention. Patients have the last say concerning whether or not they seek medical treatment for symptoms, follow a doctor's advice or acce pt reassurance. Delay in seeking help for serious symptoms, non-compliance with treatment advice and failure of doctors to reassure many of the 'worri ed well' have long been recognized as serious problems. We argue that what is common to these important problems is patient judgement. Surveys yieldin g information about the average influence of a large number of individual v ariables do not do justice to the complex interaction of influences that ca n influence the judgements of an individual person under particular social circumstances. This is what explains the wide variety of patient reactions. From the medical standpoint, such unpredictable patient behaviour seems ir rational. The patient perspective on the meaning of their actions is a hiat us in our knowledge, which is hampering the planning of effective intervent ions. Too few studies have sought the perspective of patients by asking the m why they acted as they did. Thus, the wide spectrum of patient response i n these situations in relation to personality, life experience and social c ontext cannot be studied without interpretive field studies that include in terview of patients with qualitative interpretation.