The patient-practitioner interaction in post bariatric surgery consultations: an interpersonal process recall study

Abstract

Purpose

The patient-practitioner relationship is fundamental to rehabilitation practice and patients’ health and wellbeing. Dissonance between patients who have had bariatric surgery and health care practitioners about what supportive care and good outcomes are can undermine care. To address the mechanisms of this process, we conducted an Interpersonal Process Recall study.

Materials and Methods

We interviewed patients (11), video recorded consultations (10), conducted video-assisted individual interviews with patients (10) and practitioners (11) and a dyadic data analysis.

Results

We identified relational states and shifts in the clinical encounter 2–3 years post-surgery, described in themes: a) Playing by the Book – Making it Easier for Each Other, b) Down the Blind Alley – Giving up on Each Other, and c) Opposite Poles – Towards and Away from Each Other.

Conclusions

The post-surgery consultations facilitated responsibility for health and self-care but did not invite dialogues about the psychosocial burdens of living with obesity and undergoing bariatric surgery. Patients and practitioners tried to avoid creating conflict, which in turn seemed to foster distance, rather than human connection. This limits the encounter’s benefit to both parties, leaving them frustrated and less willing to either meet again or take any gains into their future lives.

IMPLICATIONS FOR REHABILITATION

• Illness evokes feelings of stress and uncertainty and is experienced very differently from the perspective of patients and health care practitioners (HCPs), who encounter each other in a field fraught with tension.

• Bodily changes and difficult emotions related to food and eating are to be expected when undergoing bariatric surgery, and to explicitly “notice, name and validate” emotions can promote the patient’s capacity to sustain self-care, lifestyle change, weight loss and health gains.

• Making interpersonal connection and interaction between patient and HCP the centre of bariatric aftercare can enhance engagement in and outcomes of the post-surgery clinical encounter

Keywords:

• Bariatrics
• communication
• dyadic analysis
• intersubjectivity
• obesity treatment
• patient-provider interaction
• qualitative research
• relationship building

Acknowledgements

The authors thank all the interview participants and the group service users collaborating with the researchers throughout the research process. The authors are grateful to the health professionals and administrators providing access to the obesity clinics and recruiting interview participants.

Author contributions

EN conceived the study and led the data collection, analyses and writing of the manuscript. EN and KOL collected the data. EN, KOL, JO and CM participated in the interpretations of findings. All authors read and approved of the final manuscript.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Correction Statement

This article has been republished with minor changes. These changes do not impact the academic content of the article.

Additional information

Funding

This research was funded by the Research Council of Norway, grant number 269097.