Kirsti Malterud and Hanne Hollnagel (Denmark) have been collaborating on this project 1995-2004.
Main points:
The healing and preventive powers of people’s health resources and self-assessed knowledge have so far been grossly underestimated in medicine. In this project, we call attention to ethical and epistemological dilemmas related to knowledge, values, communication, and autonomy embedded in the prevailing risk-oriented epidemiology, and suggest a patient-centred salutogenetic approach to promote a better balance between resources and risks in medicine through.
Identification and intervention upon risk factors can provide hypotheses about origins of disease and predict and sometimes prevent disease at a group level. However, there are several pitfalls related to this perspective concerning causal factors, group level based possibilities, adequate end points for intervention, informed consent, and medicalization, especially in the individualized context of the clinical encounter.
By introducing a salutogenic perspective, we urge to shift the attention toward resources, agency and strength, which may counteract risk of disease and empower the patient. Talk can mediate oppression as well as empowerment. A communicative key question approach, and self-assessed health resources identified through this strategy, are presented as examples of empowerment through dialogue.
Publications from this project:
- Hollnagel H, Malterud K. Sundhedsbrøken der blev væk. Vejen fra ide til projekt om selvvurderede helbredsressourcer. Månedsskr for Prakt Lægegern 1995; 73: 693-701.
- Hollnagel H, Malterud K. Shifting attention from objective risk factors to patients' self-assessed health resources. A clinical model for general practice. Family Practice 1995; 12: 423-9.
- Malterud K, Hollnagel H. The magic influence of classification systems. Scand J Prim Health Care 1997; 15: 5-6.
- Malterud K, Hollnagel H. Fra risikojakt til ressursmobilisering - fra teori til allmennpraksis. Nordisk Medicin 1997;112:288-91.
- Malterud K. Ressurser versus risiko. I: Hunskår S, red. Allmennmedisin. Klinisk arbeid. Oslo: Ad Notam Gyldendal, 1997: 685-6.
- Malterud K, Hollnagel H. Women's self-assessed personal health resources. Scand J Prim Health Care 1997;15:163-8
- Malterud K, Hollnagel H. Talking with women about personal health resources in general practice Key questions about salutogenesis. Scand J Prim Health Care 1998;16:66-71.
- Hollnagel H, Malterud K. Patientens stærke sider. I: Kjær A, Berendth E, red. Kvindelige læger ser på sundhed og sygdom. København: Danske Kvindelige Lægers Forening, 1998: 90-9.
- Malterud K, Hollnagel H. Encouraging the strengths of women patients - A case study from general practice on empowering dialogues. Scand J Publ Health 1999;27:254-9
- Malterud K, Hollnagel H. Snakk om ressurser – noe annet enn risiko! I: Swensen E, red. Diagnose Risiko – ikke syk, ikke frisk. Oslo: Tano-Aschehoug, 2000:137-47
- Hollnagel H, Malterud K, Witt K. Men’s self-assessed personal health resources. Approaching patients' strong points in general practice. Family Practice 2000;17:529-34
- Hollnagel H, Malterud K. From risk factors to health resources in medical practice. Medicine, Health Care and Philosophy 2000;3:257-64
- Hollnagel H, Malterud K. Patientens egen vurdering af sit generelle helbred og sine stærke sider. Månedsskr for Prakt Lægegern 2001;79:985-92.
- Malterud K, Hollnagel H, Witt K. Gendered health resources and coping. A study from general practice. Scand J Publ Health 2001;29:183-88.
- Malterud K. Kan allmennlegen være healer? Om medisinske tradisjoner, lege-pasient-forholdet, salutogenese og empowerment. Tradisjon 2001;31 (2): 77-83.
- Hollnagel H, Malterud K. Samtaler om risiko og helbredsressourcer i almen praksis Ugeskr Læger 2002; 164: 164: 5225-9.
- Malterud K, Hollnagel H. Positive self-assessed health in patients with medical problems. A qualitative study from general practice . Scand J Prim Health Care 2004; 22:11-5. .
- Malterud K, Hollnagel H. Nøglespørgsmål i konsultationen. En klinisk kommunikativ metode. Ugeskr Læger 2004; 166: 2034-5.