PDF(Pubmed)
Abstract：
BACKGROUND: There is a discussion among general practitioners and psychiatrists regarding over-diagnosing versus under-reporting of psychiatric diagnoses. A deeper understanding of this topic is relevant for providing reasonable health care and for planning future studies. A crucial factor to understanding this discussion is the difference in the prevalence of a disease in each sector. One way to attain knowledge about such prevalences is the analysis of routine care data of the sector in question. However, diagnosis-related data might be modified by several additional influencing factors.
OBJECTIVE: This study aims to explore what kind of motives and modifying factors play a role for or against giving psychiatric diagnoses in psychiatric and general medical settings.
METHODS: Twenty-six semi-structured interviews were conducted with German physicians in the fields of general medicine and psychiatry. Interviews were analysed using content analysis.
RESULTS: The analysis revealed three major motivational categories for finding a diagnosis: (1) \"objective matters\" such as \"categorisation for research\"; (2) \"functional and performance-related factors\" such as \"requirement for medication\", \"billing aspects\" that go with certain diagnoses or \"access to adequate care\" and (3) \"Individual factors\" such as the \"personality of a physician\". Similarly, factors emerged that lead to not making psychiatric diagnoses like \"fear of stigmatization among patients\" or \"detrimental insurance status with psychiatric diagnosis\". Additionally participants mentioned other reasons for \"not diagnosing a psychiatric diagnosis\", such as \"coding of other clinical pictures\".
CONCLUSIONS: The diagnostic process is a complex phenomenon that goes far beyond the identification of medical findings. This insight should be considered when processing and interpreting secondary data for designing health care systems or designing a study.
OBJECTIVE: This study aims to explore what kind of motives and modifying factors play a role for or against giving psychiatric diagnoses in psychiatric and general medical settings.
METHODS: Twenty-six semi-structured interviews were conducted with German physicians in the fields of general medicine and psychiatry. Interviews were analysed using content analysis.
RESULTS: The analysis revealed three major motivational categories for finding a diagnosis: (1) \"objective matters\" such as \"categorisation for research\"; (2) \"functional and performance-related factors\" such as \"requirement for medication\", \"billing aspects\" that go with certain diagnoses or \"access to adequate care\" and (3) \"Individual factors\" such as the \"personality of a physician\". Similarly, factors emerged that lead to not making psychiatric diagnoses like \"fear of stigmatization among patients\" or \"detrimental insurance status with psychiatric diagnosis\". Additionally participants mentioned other reasons for \"not diagnosing a psychiatric diagnosis\", such as \"coding of other clinical pictures\".
CONCLUSIONS: The diagnostic process is a complex phenomenon that goes far beyond the identification of medical findings. This insight should be considered when processing and interpreting secondary data for designing health care systems or designing a study.
摘要：
背景：全科医生和精神科医生之间有关于精神病诊断的过度诊断与漏报的讨论。对该主题的更深入了解对于提供合理的医疗保健和规划未来的研究至关重要。理解这一讨论的一个关键因素是每个部门疾病患病率的差异。获得有关此类流行情况的知识的一种方法是分析有关部门的常规护理数据。然而,与诊断相关的数据可能会受到其他几个影响因素的影响。
目的：本研究旨在探讨在精神病和普通医疗环境中，什么样的动机和修饰因素在进行精神病诊断中起作用或反对作用。
方法：对普通医学和精神病学领域的德国医生进行了26次半结构化访谈。使用内容分析对访谈进行了分析。
结果：分析揭示了发现诊断的三个主要动机类别：（1）“客观事物”，例如“研究分类”；（2）“功能和性能相关因素”，例如“药物要求”，与某些诊断或“获得适当护理”相关的“帐单方面”和（3）“个人因素”，例如“医生的个性”。同样，出现了导致无法进行精神病诊断的因素，例如“患者对污名化的恐惧”或“精神病诊断的有害保险状况”。此外，参与者还提到了“未诊断精神病诊断”的其他原因，如“其他临床图片的编码”。
结论：诊断过程是一个复杂的现象，远远超出了医学发现的识别。在处理和解释用于设计医疗保健系统或设计研究的次要数据时，应考虑这种见解。
目的：本研究旨在探讨在精神病和普通医疗环境中，什么样的动机和修饰因素在进行精神病诊断中起作用或反对作用。
方法：对普通医学和精神病学领域的德国医生进行了26次半结构化访谈。使用内容分析对访谈进行了分析。
结果：分析揭示了发现诊断的三个主要动机类别：（1）“客观事物”，例如“研究分类”；（2）“功能和性能相关因素”，例如“药物要求”，与某些诊断或“获得适当护理”相关的“帐单方面”和（3）“个人因素”，例如“医生的个性”。同样，出现了导致无法进行精神病诊断的因素，例如“患者对污名化的恐惧”或“精神病诊断的有害保险状况”。此外，参与者还提到了“未诊断精神病诊断”的其他原因，如“其他临床图片的编码”。
结论：诊断过程是一个复杂的现象，远远超出了医学发现的识别。在处理和解释用于设计医疗保健系统或设计研究的次要数据时，应考虑这种见解。
