Journal of Health and Social Behavior
A Critical Theory of Medical Discourse: Ideology, Social Control, and the Processing of Social Context in Medical Encounters [статья]
Опубликовано на портале: 23-03-2007Howard Waitzkin Journal of Health and Social Behavior. 1989. Vol. 30. No. 2. P. 220-239.
The personal troubles that patients bring to doctors often have roots in social issues beyond medicine. While medical encounters involve "micro-level" interactions between individuals, these interpersonal processes occur in a social context shaped by "macro-level" structures in society. Examining prior theories pertinent to medical discourse leads to the propositions: (a) that medical encounters tend to convey ideologic messages supportive of the current social order; (b) that these encounters have repercussions for social control; and (c) that medical language generally excludes a critical appraisal of the social context. The technical structure of the medical encounter, as traditionally seen by health professionals, masks a deeper structure that may have little to do with the conscious thoughts of professionals about what they are saying and doing. Similar patterns may appear in encounters between clients and members of other "helping" professions. Expressed marginally or conveyed by absence of criticism about contextual issues, ideology and social control in medical discourse remain largely unintentional mechanisms for achieving consent.
Опубликовано на портале: 04-03-2007Robert E. Clark, Emily E. LaBeff Journal of Health and Social Behavior. 1982. Vol. 23. No. 4. P. 366-380.
This research focuses on the strategies used by various professionals in delivering news of death. The lack of well defined, normative guidelines for such deliveries adds to the problematic nature of the interaction. From in-depth interviews with physicians, nurses, law enforcement officers, and clergy, a loose framework based on common themes was generated providing a processual view of death telling. Five distinct strategies of delivery developed within the framework. Discussion of each strategy indicates the significance of situational and occupational factors in delivering news of death. This study, though exploratory in nature, clarifies some of the processes involved in the delivery of bad news, and identifies several important problems surrounding death telling, such as lack of training and preparation among professionals for this role and their dislike for this aspect of their work.
Information Giving in Medical Care [статья]
Опубликовано на портале: 23-03-2007Howard Waitzkin Journal of Health and Social Behavior. 1985. Vol. 26. No. 2. P. 81-101.
Information giving is a crucial element of medical care. This research project considered two theoretically grounded hypotheses: (1) Doctors may withhold information and maintain uncertainty to preserve power in the doctor-patient relationship, and (2) class-based sociolinguistic differences in language use may create further impediments to information giving. A multivariate research model was operationalized to study these hypotheses and to assess other associations between information giving and the characteristics of doctors, patients, and the clinical situations in which they interact. An analysis of a sample of 336 encounters recorded from several outpatient settings revealed that doctors spent little time informing their patients, overestimated the time they did spend, and underestimated patients' desire for information. Contingency-table analysis showed that information transmittal was associated with (1) doctors' income, social class background, political ideology, and perceptions of patients' informative needs; (2) patients' age, sex, social class, education, and prognosis; and (3) situational characteristics such as the length of acquaintance, numbers of patients seen per day, and the types of patients in the doctors' practices. Multiple regression analysis assessed the relative importance of these variables in explaining the variation in information transmittal. The findings did not clearly confirm a relationship among information withholding, uncertainty, and power but did clarify the importance of class-based sociolinguistic barriers to communication.
Опубликовано на портале: 23-03-2007Renee R. Anspach Journal of Health and Social Behavior. 1988. Vol. 29. No. 4. P. 357-375.
This paper examines a segment of medical social life that has not been studied extensively: formal presentations of case histories by interns, residents, and fellows. Because they are presented by physicians in training to their status superiors, who are evaluating them, case presentations are exercises in self-presentation which serve as a vehicle for professional socialization. This analysis of the language of case presentation is based on case presentations collected in two intensive care nurseries and an obstetrics and gynecology service. Four features of case presentation are identified: 1) the separation of biological processes from the person (de-personalization); 2) omission of the agent (e.g., use of the passive voice; 3) treating medical technology as the agent; and 4) account markers, such as "states," "reports," and "denies," which emphasize the subjectivity of patients' accounts. The language of case presentation has significant, if unintended, consequences for those who use it. First, some features of case presentation eliminate the element of judgment from medical decisions and mitigate responsibility for medical decision making. Second, some are rhetorical devices which enhance the credibility of the findings that are presented. Third, the language of case presentation minimizes the import of the patient's history and subjective experience. Finally, case histories socialize those who present them to a culture or world view which may contradict the explicit tenets of medical education.
Perceptions of Patients by Emergency Room Staff: Substance-Abusers versus Non-Substance-Abusers [статья]
Опубликовано на портале: 23-03-2007Lois Biener Journal of Health and Social Behavior. 1983. Vol. 24. No. 3. P. 264-275.
Studies suggest that health care providers' evaluation of patients is related to aspects of the presenting problem, i.e., its seriousness, curability, and rarity; the extent to which the problem was self-caused; and to aspects of the patients, i.e., their age, social distance from providers and cooperativeness. Analysis of 220 emergency room staff members' perceptions of 14 hypothetical patients showed that with the exception of rarity of problem and social distance, the tested factors were significantly related to ratings of rewardingness of patient encounters. Results indicated that predictors of reward derived from substance-abusing and non-substance-abusing patients were different. While seriousness of illness was the primary predictor with non-substance-abusers, perceived cooperativeness was primary with substance-abusers. Predictors of rewarding patient encounters also differed according to staff level. Implications of these differences for emergency treatment of substance-abusers is discussed.
Опубликовано на портале: 23-03-2007Mary Klein Buller, David B. Buller Journal of Health and Social Behavior. 1987. Vol. 28. No. 4. P. 375-388.
Research has linked the communication styles of physicians to patients' satisfaction with health care. Recently Ben-Sira (1976, 1980) offered a social interaction model to explain this relationship; this model, however, focused on a single, narrow style of communicating and overlooked the broader spectrum of styles. This survey assessed two general communication styles: affiliation and control. It also examined eight social characteristics of medical interviews as possible mediators of the impact of the physician's communication style on the patient's satisfaction. Patients' evaluations of the physician's communication were associated strongly with patients' evaluations of medical care, suggesting that competence in communication may be a facet of medical competence. Affiliative styles were related positively to patients' satisfaction, whereas dominant/active styles had a negative relationship with satisfaction. Severity of the illness, physician's age, physician's specialty, and the number of prior visits affected the importance of the physician's communication in the patient's evaluations of care.
Опубликовано на портале: 23-03-2007Catherine Ross, John Mirowsky, Raymond S. Duff Journal of Health and Social Behavior. 1982. Vol. 23. No. 4. P. 317-329.
Authors developed and tested a model of client satisfaction with medical care in which sociodemographic characteristics of the physician affect client satisfaction under conditions of unmet expectations and a lack of choice. They hypothesized that in small fee-for-service practices such as solo practice, where the client chooses his or her physician, status characteristics of the doctor would be unrelated to client satisfaction. Conversely, in large prepaid group practices where the client is assigned a physician, nonnormative physician status characteristics would create lower client satisfaction. Because expectations are based on statistical norms, it was hypothesized that clients in large prepaid multispecialty groups would be most satisfied with physicians who fit the norm-middle-aged white males from higher status Protestant or Jewish backgrounds. In a sample of pediatricians and their clients, authors found their hypotheses to be strongly supported, with one modification-the relationship between client satisfaction and the physician's socioeconomic background is parabolic. Furthermore, the negative effect of nonnormative physician religious status on client satisfaction in large prepaid groups is offset by the client-physician match and by experience with the physician.
Опубликовано на портале: 23-03-2007Marie R. Haug, Bebe Levin Journal of Health and Social Behavior. 1981. Vol. 22. No. 3. P. 212-229.
Traditionally, the sociological concept of the relationship between practitioner and patient has been the sick role, in which the physician as practitioner is in charge, and the patient is obligated to cooperate with the physician's prescribed regimen. More recently, this power relationship has been redefined by some from a consumerist perspective, in which physician and patient bargain over the terms of the relationship. Although each brings different resources to the encounter, neither participant is automatically in charge. Data from a sample of 466 members of the public and 86 physicians are used to assess the extent of reported public attitudes and behaviors that challenge the physician's traditional power, as well as physicians' reported response to such attitudes and events, as evidence of the public's propensity to a consumerist relationship and physicians' willingness to accept it. Among both the public and physicians, substantial minorities express beliefs and report actions congruent with this consumerist perspective. However, different demographic and health belief variables emerge in the two groups as explanatory factors. Doctor-patient power relationships are seen to depend on characteristics of the actors as well as on the illness situation.
Returning to the Doctor: The Effect of Client Characteristics, Type of Practice, and Experiences with Care [статья]
Опубликовано на портале: 23-03-2007Catherine Ross, Raymond S. Duff Journal of Health and Social Behavior. 1982. Vol. 23. No. 2. P. 119-131.
Although a number of policy-makers have suggested that previous experiences with medical care affect subsequent use of physician services, few researchers have examined the issue empirically. Authors divide the determinants of revisiting the doctor in pediatric practice into three categories: client characteristics, organizational characteristics, and characteristics of the doctor-client interaction; and we develop a causal model. Although race, income, and education have no direct effects on the frequency of returning to the doctor, they have indirect effects through the organization of health care and experiences within the health care system. Clients who are poorly educated tend to have consistently negative experiences with the health care delivery system. These experiences affect subsequent use of services. Positive experiences with the interpersonal, psychosocial aspects of the doctor-client interaction increase a client's proclivity to return to the doctor, while negative doctor-client interactions decrease the probability of returning to the doctor.