Marseille 2007
Marseille 2007
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Abstract #410  -  Dealing with patients complaints about HAART side effects: a study of physician behaviour within medical consultations in France
Session:
  38.2: Counselling and Therapy (Parallel) on Tuesday @ 14.00-16.00 in CP Chaired by Barbara Hedge, Michael Blank
Authors:
  Presenting Author:   Ms Isabelle Wallach - Universit du Qubec Montral, Canada
 
  Additional Authors:   
Aim:
HAART side effects represent one of the major problems of HIV healthcare. Deteriorating the well-being and even the health of people living with HIV, medication side effects have negative repercussions on their individual and social life and damage their quality of life. Moreover, literature shows that these symptoms, and more particularly their subjective experience, represent an important factor of observance failure among patients. Considering the stake that taking care of medication side effects in the context of HIV infection represents, this study aims at analyzing how patients complaints about these side effects are taken into account and treated by the physicians.
 
Method / Issue:
The study is based on an ethnographic investigation undertaken with six doctors, within two french hospital services specialized in HIV treatment, during a two years period. It relies on the observation of 250 medical consultations, as well as on informal discussions and semi-structured interviews conducted with the physicians.
 
Results / Comments:
This study first analyzes the reactions of the doctors towards the complaints of patients related to symptoms which they blame on the treatment. It highlights a tendency of the doctors to question the medicamentous origin of the disorders reported by the patients. Indeed, recognizing the symptom as being a side effect would legitimate the request of the patient to change the treatment. Analysis of the medical consultations shows that the divergence of points of view between doctors and patients on the cause of the symptom can give rise to negotiations and sometimes to tensions between them. These tensions concern, in particular, the question of the responsibility of the patient in the genesis of his disorder. Secondly, this study focussed on the elements influencing the decision to modify the treatment, in the cases when treating the symptoms did not manage to stop the disorder. Analysis of the consultations and of the interviews carried out with the doctors reveals that their way of dealing with side effects depends on the leeway they have regarding therapeutic alternatives and, at the same time, on their perception of the seriousness and objectivity of the adverse effect reported by the patient, according to the medical perspective.
 
Discussion:
The whole of the results shows that the reaction of the doctors vis-a-vis the undesirable effects reported by the patients depends upon their judgement of the causes and the objectivity of these symptoms, which can sometimes prevent the doctors from attaching the same importance to all these adverse effects. As a result, divergence of point of view on the disorders between the doctors and the patients can give the patients the impression that their experience of the treatment is not recognized. This is likely to lead some of these patients to stop the treatment or to follow it in an irregular way.
 
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