“I've not asked him, you see, and he's not said”: understanding lay explanatory models of illness is a prerequisite for concordant consultations

Abstract

Abstract Method An extended qualitative analysis of a single case. Objective To illustrate the complexity of patients' explanatory models and their significance in underpinning experience of illness and response to disease. Key findings The case demonstrates how lack of professional awareness and understanding of patient models limits the capacity to provide effective health care and reduces patients' ability to cope with the experience of illness or to participate constructively in the management of disease. The distance between patients and health professionals is likely to increase, as also is the rate of “non-compliance”, if laypeople continue to become increasingly well informed outside the consulting room, but retain the traditional role of passive and acquiescent patient within it. Concordant consultations are characterised by attention to the patient's illness as well as disease. It is not enough that technical issues and disease problems should be dealt with. The patient's subjective experience of symptoms, and the personal significance of his or her illness should be set out. The interpretation of meaning should be a collaborative endeavour involving both doctor and patient. Increased professional awareness of patient models of illness and associated concerns could be an important lever in changing the culture of the consultation. Conclusion Concordance offers a way of developing a more equal and meaningful relationship between patients and professionals and of generating more positive outcomes in medical consultations as a result.