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Table 3 Factors influencing doctor–patient relationships at the beginning of the narratives

From: Use of narrative medicine to identify key factors for effective doctor–patient relationships in severe asthma

  Core Narratives Contingent Narratives Moral Narratives
Easy Difficult Easy Difficult Easy Difficult
Emotions at the first visit (Adult patients) (N = 79) (N = 57) (N = 38) (N = 31) (N = 3) (N = 10)
Fear and sadness 52% 44% 45% 45% 33% 30%
‘The patient seemed depressed […] since he was particularly hindered by his symptoms in daily activities’. ‘The patient was afraid and worried about the future since he was able to assess the severity of his disease through the high number of positive prick tests’.
Submission 20% 28% 3% 32% 33% 20%
‘The patient told me it was still difficult for her not to consider herself as a sick person, at life-threatening risk’. ‘“Doc, they’ve tried everything, you’re not going to tell me that there are further drugs to try, are you? I’ve been sick for 10 years!” I tried to explain to her that new drugs really exist...’
Positive 11% 2% 37% 0% 0% 20%
‘At every visit, he appeared me calm and relaxed, not revealing any sort of fear or worry’. ‘The patient appeared to be aware of the gravity of his health status, but calm. He was serene when he told me about his allergy and the worsening of its symptoms’.
Hate and anger 1% 17% 8% 16% 0% 30%
‘During the visit, the patient was upset, with a defiant attitude’. ‘The patient appeared to be tired, uninspired and angry with his situation and clinical condition’.
Anticipation 16% 9% 8% 6% 33% 2%
‘I think that the patient cheered himself up, then asked me for more information about the new therapeutic options’. ‘During the communication of re-evaluation results, I think the patient felt hope for the possibility of trying a new therapy’.
Emotions at the first visit (Paediatric patients) (N = 26) (N = 13) (N = 7) (N = 6) (N = 5) (N = 4)
Fear and sadness 46% 46% 57% 0% 40% 75%
‘The patient seemed sad, without dreams or hope. He explained his health status in a detached manner’. ‘In a sense, he felt different from other children because of asthma – he could not play soccer, the most interesting thing to him – so he viewed himself as the “ugly duckling”’.
Submission 4% 0% 0% 33% 0% 0%
‘When I saw this little girl under a beach umbrella near mine, she stayed still, while other guys, her cousins, were playing and moving around her’. ‘The patient seemed to me to be quite passive, of few words – he had half-opened eyelids and a half-opened mouth’.
Positive 19% 8% 43% 0% 40% 0%
‘That day, they entered my clinic smiling and quite happy to see me’. ‘At her arrival at the clinic, she was smiling and miming a sort of embrace’.
Hate and anger 8% 38% 0% 50% 0% 25%
‘The boy was uncomfortable and anxious to exit from the room and stop our visit’. ‘His eyes were looking to me as if he didn’t want to be there at that moment’.
Anticipation 23% 8% 0% 17% 20% 0%
‘In the afternoon he visited me to certify his ability to participate in sports, at which he really wanted to do well; however, he told me to be calm since he was feeling good at that period of time’. ‘The little girl child was sawing through me with her big black eyes’.
Emotions at the first visit (RSs in regard to adult patients) (N = 72) (N = 6) (N = 50) (N = 39) (N = 3) (N = 10)
Fear and sadness 17% 19% 9% 24% 0% 11%
‘I felt powerless and afraid. She couldn’t survive alone in such a severe condition, not only of her illness but of her family situation’. ‘So, I felt despondent… she was not even allergic, so I could not even use my best therapeutic options’.
Submission 1% 2% 0% 6% 0% 0%
‘Actually, when the patient has a relapse or when unusual symptoms had occurred, he will be more anxious and afraid for his health status, so he uses to go on visit each time he wants, without prior notice’
Positive 17% 4% 20% 0% 0% 11%
‘The patient told me to be calm, so I reflected his emotions’. ‘I felt good – I was encouraged by the patient since, although I was asking her to come back very often to the hospital for treatment, she appeared to be happy’.
Hate and anger 0% 14% 3% 35% 0% 44%
‘I felt angry and powerless when I tried to convince her to take care of herself’. ‘I saw for the umpteenth time that the patient had not taken any of the treatment I had prescribed, in spite of severe asthma he suffered from’.
Anticipation 65% 61% 69% 35% 100% 33%
‘He felt hope in regard to his treatment as if it could restore his serenity and calmness. He wished his girlfriend could get a good treatment for the symptoms she had. So I felt I was complicit with the couple in restoring the everyday energy they had in the past’.
Emotions at the first visit (RSs in regard to children) (N = 23) (N = 11) (N = 6) (N = 6) (N = 5) (N = 4)
Fear and sadness 9% 7% 0% 0% 0% 0%
I was sad because her mother was crying’.
Submission 0% 0% 0% 0% 0% 0%
Not Applicable (N/A)
Positive 9% 0% 33% 0% 40% 25%
‘The child was listening to me with interest, so she asked: “Can you cure me?” I smiled at her, answering that surely I would try with her parents to make her feel better’.
Hatred and anger 17% 43% 33% 33% 0% 50%
‘The patient seemed like abully”, like an uncaring guy who only wants to appear sure of himself’. ‘The re-evaluation visit was very poor since neither the patient nor his family were aware of the privilege they had if they would accept a new, effective, and expensive therapy!!’
Anticipation 65% 50% 33% 67% 60% 25%
‘His family hoped I could have found a solution for the suffering of their child. So I felt a great responsibility towards them’. ‘I left the patient with one of my colleagues… Coming back home, I was tired but happy knowing the patient was feeling better. I reflected myself and tried to understand if the patient worsened because he was not adherent or because physicians hadn’t followed him in the correct way... doubts that I would like to clarify the following day’.