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Sammanfattning

BACKGROUND : The objective of this project was to develop a clinical communication tool to change locked dialogues between doctor and patient in general practice consultations. The target group was patients suffering from long-standing symptoms without clinical findings. Patients were encouraged to keep an illness diary or to write personal notes on their illness as a tool for cooperating with the doctor. MATERIAL AND METHODS : The material was collected from 36 consultations with 16 patients. The qualitative evaluation aimed at giving a description and analysis of how the illness diary affected the doctor-patient dialogue in the consultation. The analysis was modified from phenomenology-based methodology. A part of the project dealt with the methodological problems of doing research on an interaction in which the general practitioner is both participant (doctor) and observer (researcher). RESULTS AND INTERPRETATION : The diary enhanced the doctor's basis for clinical decision making by giving medically relevant information from the patient and by producing more concrete information. The diary gave the doctor access to patients' insight in their own problems. The clinical dialogue modified the patient's negative internal monologues in order to search for alternate dialogues as a basis for personal coping strategies. The project demonstrated that written notes might give patient and doctor a new understanding of a previously spoken message. The writing procedure gave patients an opportunity to reflect upon their illness presentation.

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