Dealing with doubt. How patients account for non-specific chronic low back pain.
OBJECTIVE
To explore the ways that persons with long standing chronic low back pain respond to the problem of medical doubt about the presence of organic pathology.


METHODS
Qualitative analysis of accounts provided by 12 persons attending a back pain rehabilitation clinic in NW England.


RESULTS
Subjects rejected the notion that they were culpable for their pain. They were not culpable for the onset of their pain. They argued that despite their cooperation, no sensible explanation of their pain was forthcoming from health professionals. Finally, they asserted that medical scepticism had been damaging and dispiriting.


CONCLUSIONS
Patients dealt with clinical doubt by stressing their own expertise. They constituted their beliefs about the cause and trajectory of their pain and disability as accurate accounts of their disability. They resisted the suggestion that there might be psychological factors involved in their ill-health by locating culpability among clinicians, who were confused or uncertain about diagnosis and treatment.
May
C R
CR
Rusholme Health Centre, School of Primary Care, University of Manchester, Walmer Street, Manchester M14 5NP, UK. cmay@fs1.rgp.man.ac.uk
Rose
M J
MJ
Johnstone
F C
FC
D000328:Adult; D001294:Attitude to Health; D002908:Chronic Disease / Q000523:psychology; D004185:Disability Evaluation; D004739:England; D005260:Female; D006801:Humans; D017116:Low Back Pain / Q000191:economics / Q000523:psychology* / Q000534:rehabilitation; D008297:Male; D008875:Middle Aged; D010353:Patient Education as Topic; D017060:Patient Satisfaction / Q000706:statistics & numerical data*; D010817:Physician-Patient Relations; D012047:Rehabilitation Centers; D012494:Sampling Studies; D014942:Workers' Compensation