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Table 8 Other 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

Negative factors Narratives examples
- Obesity “L. is a middle-aged lady who’s been suffering from asthma for almost all her life; she’s allergic to dust mites and pollen, she’s always had anxiety and obesity issues. Lately, her anxiety worsened, together with her weight gain”; “Metaphor: Dear whale; the patient told me she was completely handicapped in her daily activities. She could not walk without experiencing shortness of breath, so she never went out alone. Immediately, she started crying and said her obesity was the reason for her unhappiness and illness. She had pledged to eat less, to no avail”.
- Smoking “I must confess it was very annoying for me: when they came to see me, I sometimes didn’t even visit F. I used to explain in detail how damaging it was for their daughter to be exposed to their passive smoke and ask them to be careful, because the pharmacological therapy could be compromised by smoke. They justified themselves saying they only smoked on the terrace, and only rarely inside the house, and never in the same room where the kid was. So, they were convinced they were not doing F. any harm”; “She continued smoking 2-3 cigarettes per day and she even confessed me she smoked marijuana 3-4 times a week. I tried to discourage her from the habit of smoking, but I haven’t obtained any result. I invited the patient to stop smoking, but the patient refused the very idea”.
- On-line researches “This patient is the kind of person who likes to ask plenty of questions, carefully assessing the pros and cons before making a decision. I thought she was one of those difficult patients who have a list of questions ready each time and do a lot of on-line research, asking me for reassurance on the therapies I had proposed”; “The follow-up visit was peculiar; the patient was hasty, she did not want to listen to me, but only to propose something she’d read on-line or on some magazine. The patient seemed to be confused about all the aspects of the matter, because she was too involved in the media”.
- Homeopathic therapies “She immediately said she was against medical treatments, because she preferred homeopathic drugs. Sincerely, I don’t know what this lady was feeling, because she was too distant from me, so it was impossible for me to catch any impression of her. After explaining for 30 minutes what asthma is, how to treat it, what mistakes are not to be done with it, she insisted on me prescribing some homeopathic drugs, so I felt a strong sense of rebellion against it. I thought I had to explain her everything from the beginning once again, but I did not feel like it; in addition, talking with her was really unsatisfying for me”; “I explained her that homeopathic drugs could be very dangerous, because they are completely useless in the treatment of pathologies with uncontrolled symptoms, as severe asthma. In addition, using these drugs could increase the risk of recurrent exacerbations and hospitalization (uncontrolled asthma). All the same, the patient continue to apparently agree with me, but just formally, showing she had indeed understood but she was not REALLY aware of what I had just explained, even about the risk of exacerbations if she persisted in using homeopathic drugs that totally exclude the allopathic treatment”.
- The hyper-protective of pediatric patients “I could not understand why no one before me had the child’s health as a priority. In addition, I could not understand why such an anxious and careful mother didn’t take her child to another doctor for a second opinion. The kid seemed particularly low, resigned and a little bit difficult, while his hyper-anxious mother was explaining to me each bronchospasm episode in details. […] His parent was in crisis; his mother was doubtful and terrified by the potential side effects of the biological therapy I proposed. […] I thought they were foolish to reject my proposal to change therapy!”
- absent families of pediatric patients “The patient told me he felt better with the new therapy, while his parents said they were not so attentive with him, so they didn’t show so much enthusiasm about it; … I felt frustration. […] and I thought that he would probably suspend the therapy, because his family did not feel like coming to the hospital so frequently”.
- Prior hospitalizations of asthmatic children “S. and her young mother had a bewildered and fearful look: in their eyes there was the terror of future hospitalizations and other bad experiences. The kid didn’t speak a word, she just sat there, next to her mother. She carefully observed her surroundings, trying to catch just a “sign” in my gestures, in my eyes and in my words. […] On that occasion I tried to reassure them by saying that all these feelings were normal after this kind of ordeal. I told them that we would have had frequent visits over the following months, in order to bring the kid’s asthma under control”. “She was just 2 years old: her pediatrician had suggested further examinations, because of her recurrent and often severe episodes of bronchospasm, that in some cases had led to hospitalization. […] Some of her positive attitude rubbed off onto me: I was calm and happy to be part of their family. We were all aware we were going to make it!!”