Perspectives on power, communication and the medical encounter (original) (raw)
Related papers
Nursing Inquiry, 1995
Pagpectrpes on power, communication and the medical encounter: implications for nursing theory and practice Over the past few decades there has been an increasing push towards ‘nhancing’ communication in the medical encounter, with a focus on moving towards a ‘mutuality’ of patient and health care professional that reduces a perceived ‘power imbalance’ between the two. Doctors in particular have been consmcted as dominating and coercive, either consciously or unconsciously repressing patient's capacity for autonomy. Nurses have typically been represented as less authoritarian in their dealings with patients in their idealized role as caring, kindly and empathetic health professionals. It is therefore often argued that the nurse-patient relationship is more ‘equal’ and less repressive than the doctor-patient relationship. This article explores critically these assertions in the context of the Foucauldian perspective on the role of power in the medical encounter, and draws out implications for nursing theory and practice.
The patient and the relation between power-knowledge and care by nursing professionals
Escola Anna Nery
This is a study whose objective was to analyze, in the discourse of hospitalized patients, how the power of knowledge is revealed in Nursing care relations. It was developed in the qualitative perspective, having as theoretical reference the concept of power issued by Michel Foucault. The data were collected between August and December 2015 and the participants were 16 patients hospitalized in the medical and surgical clinics of a university hospital, who had the speech recorded through a semi-structured interview, after approval of the ethics committee under Opinion No. 1189934. In order to analyze the data we used the system of differentiations developed by Foucault. The results showed that the professionals exert power by the highly specialized professional knowledge and that they know what they do, so they send and control the accomplishment of the care, leading the patient to submission. It concludes that the exercise of the power to care must be based on the observance of ethi...
Power Issues in the Doctor-Patient Relationship
2001
Power is an inescapable aspect of all social relationships, and inherently is neither good nor evil. Doctors need power to fulfil their professional obligations to multiple constituencies including patients, the community and themselves. Patients need power to formulate their values, articulate and achieve health needs, and fulfil their responsibilities. However, both parties can use or misuse power. The ethical effectiveness of a health system is maximised by empowering doctors and patients to develop 'adult-adult' rather than 'adult-child' relationships that respect and enable autonomy, accountability, fidelity and humanity. Even in adult-adult relationships, conflicts and complexities arise. Lack of concordance between doctors and patients can encourage paternalism but may be best resolved through negotiated care. A further area of conflict involves the 'double agency' of doctors for both patients and the community. Empowerment of all players is not always possible but is most likely where each party considers and acknowledges power issues.
Exploring power relations embedded in medication communication processes on general medical wards
This paper reports on findings of an ethnographic study investigating communication processes for medication management in two general medical wards of an acute care hospital. In the paper, we explore power relations embedded in medication communication processes and their effects on social relations and clinical outcomes. For the purpose of this paper, medication communication was defined as verbal interactions and non-verbal cues about medication management among nurses, doctors, pharmacists and patients in their situated environments.
We're All Here for the Good of the Patient: A Dialogue on Power
Nursing Science Quarterly, 2010
Two nurse scholars, whose works have centered on power and related concepts, discuss the ideas that have shaped their concepts of power. In this conversation, they reflect on factors that constrain nurses and nursing in organizations, and consider some possibilities that could lead nurses to realize their full potential and influence in the healthcare system.
In 2013, in accordance with a provision in the Patient Protection and Affordable Care Act (2010), the U.S. government began fining hospitals with “excessive” patient readmission rates. Those working to respond to this issue have identified discharge communication with patients as a critical component. In response to this exigency and to contribute to the conversation in the Medical Humanities about the field’s purview and orientation, this article analyzes studies of and texts about communication in health and medicine, ultimately arguing that the on-going circulation of compliance rhetoric and assumptions has limited efforts to improve patient communication. The article, furthermore, considers that humanist ideals of agentic action, the patient-centered care movement’s emphasis on the patient, and biomedicine’s tendency to treat evidence-based knowledge as fixed and given may have combined to support a rationale for using patient adherence to treatment guidelines as metrics in measurement studies designed to identify effective communication strategies. Finally, the article proposes that those working in the Medical Humanities consider the value of interdisciplinary posthumanist scholarship—specifically, its treatment of agency and knowledge as emergent, distributed, and contingent—and its potential to transform or extend in productive ways the conversation about what constitutes effective communication with patients.
The clinical consultation encompasses a two-way gaze in which doctor and patient are essentially object and subject at the same time. Inevitably, however, doctor and patient are governed by a different set of rules and a different set of 'truths'. Indeed, contained within the two-way clinical gaze, there are distinct asymmetries in power/knowledge relations. Through hierarchical observation, normalising judgement, and the examination, it is the doctor who wields the overwhelming share of disciplinary power, and it is the doctor who is guided by the principles of biomedical ethics (problematic though they may be), not the patient. This calls for added responsibility on the part of the doctor to acquire and develop modes of decision-making understood as the logic of practical,
Power Sharing in Medical Consultations
Pakistan Armed Forces Medical Journal, 2020
Objective: To examine the management of power by doctors in medical consultations. The power is defined here as a dialogic, egalitarian, and patient-centered. Study Design: Qualitative study. Place and Duration of Study: Out-patient departments of Mayo Hospital, Lahore, Pakistan, from Nov 2019 fortwo weeks. Methodology: The data were collected through in-depth interviews and observations from outpatient departments of Mayo Hospital. Bourdieu's Social Practice Theory and Fairclough’s theory of Power and Language were used as a theoretical framework in the community of practice, for the interpretation of the qualitative data sets. Results: The interpretations of relational power by doctors and patients surface three themes: Power, Powerand Solidarity, and Solidarity. Although power-sharing is the modern rhetoric, it is hardly conceptualized in theselected hospital. Conclusion: With a proliferation of patient-centered approach of the medical profession, power-sharing withpatients m...
The interaction between doctors and nurses in the context of a hospital ward
Ciência e Saúde Coletiva, 2019
This article addresses a fundamental, albeit scarcely discussed, issue in health studies: the relationship between doctors and nurses. We rely on a ethnographic observation and in-depth interviews undertaken in a female ward of a public hospital in order to analyze certain aspects of these relationships, based on hermeneu-tics and science studies. The empiric observation showed that Doctors organized their practice and clinical decisions on certain abstractions and dialogued in a structured, highly specialized and restricted language. Nurses materialized medical decisions, guided by the prescriptions. They had no room to interfere in clinical decisions , being very busy with their tasks and not dominating the clinical discourse, which is crucial for discussing the decisions. In the context of this study, physicians and nurses maintained a distance established by the theory, technique and values shared by each professional group. Thus, we suggest that knowledge, practices and medical values and nurses were incommensurate with each other, and that this directly affected the health care actions performed in that setting.