title: Patients' experiences of healthcare encounters in severe irritable bowel syndrome: an analysis based on narrative and feminist theory.
abstract: OBJECTIVE
  This study aimed to explore patients' experiences of healthcare encounters in severe irritable bowel syndrome.
  
  
  BACKGROUND
  Irritable bowel syndrome is a common functional disorder with symptoms such as abdominal pain and disturbed bowel habits, the cause of which is not completely known. Treatments options are limited, and healthcare encounters in irritable bowel syndrome have been described as unsatisfying and frustrating for both patients and professional healthcare providers. Furthermore, the influence of power on healthcare encounters has long been recognised, especially regarding the disadvantaged position of those suffering from functional illness which cannot be identified by commonly used tests or investigations.
  
  
  METHODS
  We interviewed 10 patients during 2014, all attending an outpatient clinic and suffering from severe irritable bowel syndrome. Relying on narrative and feminist theory, we explored how they actively negotiate professional discourse communicated to them in the clinical encounter.
  
  
  RESULTS
  The patients' experiences of healthcare encounters in irritable bowel syndrome were mostly described as negative, and often induced feelings of confusion and self-doubt. Positive encounters were described as being listened to, believed and taken seriously. Narrators found it especially problematic when healthcare professionals described irritable bowel syndrome as a minor disorder with primarily stress or psychological aetiology and put the responsibility for recovery onto the patient. Patients' actively negotiated such professional discourse by presenting a counternarrative describing their own suffering and strengths, experienced healthcare shortcomings and possible organic aetiology of irritable bowel syndrome.
  
  
  CONCLUSIONS
  Patients suffering from severe irritable bowel syndrome described how they often felt a need to protect their positive identities in the face of trivialisation and disbelief by healthcare professionals.
  
  
  CONCLUSIONS
  A deepened understanding of patients' experiences of healthcare encounters in irritable bowel syndrome could enable more helpful and supporting interventions by healthcare professionals.
authors.affiliation: Department of Internal Medicine & Clinical Nutrition, Institute of Medicine and the Centre for Person-Centred Care (GPCC), Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden. ida.bjorkman@gu.se.
authors.forename: Ida
authors.initials: I
authors.lastname: Björkman
authors.affiliation: Department of Internal Medicine & Clinical Nutrition, Institute of Medicine and the Centre for Person-Centred Care (GPCC), Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
authors.forename: Magnus
authors.initials: M
authors.lastname: Simrén
authors.affiliation: Department of Internal Medicine & Clinical Nutrition, Institute of Medicine and the Centre for Person-Centred Care (GPCC), Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
authors.forename: Gisela
authors.initials: G
authors.lastname: Ringström
authors.affiliation: Institute of Health and Care Sciences and the Centre for Person-Centred Care (GPCC), Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
authors.forename: Eva
authors.initials: E
authors.lastname: Jakobsson Ung
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D019513:Feminism; D006785:Hospitals, University; D006801:Humans; D007407:Interviews as Topic; D043183:Irritable Bowel Syndrome / Q000451:nursing / Q000473:pathology / Q000523:psychology*; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction; D012720:Severity of Illness Index; D013548:Sweden; D055815:Young Adult
keywords: feminist theory; functional disorder; healthcare encounters; irritable bowel syndrome; narrative; patient experience; power relations