From Shame to Pride—Initiation of De-stigmatisation Processes in Review Dialogues

Abstract

People with chronic conditions often experience marginalisation, discrediting and lack of social support. Their primary contact person is usually the family doctor, who not only serves to guide the patient to appropriate support systems, but can also help with the important task of verbalising emotions and taboo topics. This chapter discusses in which ways the review dialogue, as a specific type of conversation in the context of long-term care, may explore and reflect on the process of labelling and stigmatising. Our focus is specifically on the general practitioner’s (GP’s) setting, although review dialogues are also useful in other contexts. Within the framework of the BALANCE study (DRKS00004442, 2016), a total of 125 encounters from 14 voluntarily participating GPs were videotaped and analysed using mixed methods. The case of an almost 40-year-old female patient, born in Turkey, but having grown up in Germany, was selected for our exemplary analysis. She had been treated for chronic diseases (including hypertension and depression) by her present family doctor for 10 years. The review dialogue illuminates not only the significance of her symptoms in everyday life but also the biopsychosocial multidimensionality of the situation, illustrating the psychodynamics of the family of origin and the present family. The process of review dialogue brought shame-based, suppressed and thus hidden conflicts to light, which the patient was not allowed to carry to the outside world. A key challenge of the bicultural doctor–patient interaction is to re-establish a new personal identity. Just this realisation can already contribute to the empowerment of the patient. This long-term-care case study illustrates that the review dialogue can deepen the understanding of previously collected information, possibly even leading to corrected expectations as well as interpretations by both the patient and the GP. In this way, review dialogues can contribute to an increased bridging effect between the medical world and life world, while supporting the patient’s empowerment. The chapter describes which strategies, conversational techniques and attitudes have proven to be helpful and how the patient is able to increasingly use the offered possibilities by the review dialogue. Here, a protective setting of the doctor–patient relationship that has been experienced as safe by the patient, is crucial for the outcome.