Communication & Medicine (Comm Med)

Publications in this journal

• Article: The person in the room: How relating holistically contributes to an effective patient-care provider alliance

  Leslie Penner; Kerstin Roger
  [show abstract] [hide abstract]
  ABSTRACT: The purpose of this paper is to explore how relating to the ‘whole’ person – both the physical body and the invisible aspects of the ‘self’ – is essential in the establishment of a strong therapeutic alliance between patients and health care providers. Our work is based on interviews conducted with individuals affected by neurological illnesses (patients and family care providers). Hsieh and Shannon’s (2005) conventional content analysis was used to analyze the data. Under the broad theme of ‘maintaining a coherent sense of self’ we identified four distinct sub-themes related to interactions with health care providers. The results elucidate the more complex and deep needs of patients who must access care on an ongoing basis, and highlight the important role that care providers play in supporting individuals who are experiencing physical, spiritual and social losses. Care must attend to the deep needs of these individuals by communicating in a style that addresses both emotional and cognitive needs of patients, by thorough and holistic assessment and by appropriate referrals.
  Communication & Medicine 01/2012; 9(1):49-58.
• Article: Negotiation strategies and patient empowerment in Spanish and British medical consultations.

  María de la O Hernández-López
  [show abstract] [hide abstract]
  ABSTRACT: Making a decision is not only one of the physician's most important responsibilities but also one of patients' most sensitive moments in medical encounters. Drawing from pragmatics studies, this paper explores rapport maintenance and/or enhancement (Spencer-Oatey 2000, 2008) in the decision-making strategies that General Practitioners (GPs) and patients employ in 80 encounters in various areas of England and Spain. The results show that such strategies are context-bound and subject to role specifications: while patients may make use of (dis)agreement strategies and initiate decisions and/or self-diagnosis, doctors give options, show empathy, expand explanations or show explicit or implicit (dis) agreement. In relation to this, notable findings were revealed: first, these communicative strategies may vary not only in terms of frequency but also quality and distribution; second, the Spanish interlocutors in the data gathered tend to negotiate through the explicit expression of opinions, while the British interlocutors prefer the discussion of different alternatives and value the other's freedom to act. Third, there is higher tolerance of disagreement in the Spanish data. Fourth, negotiation may be undertaken on the basis of either self-affirmation or consensus-seeking beliefs. Finally, patient empowerment is displayed in divergent ways in both sets of data. In short, the decision-making processes examined are subject to social and psychological factors with a direct impact on communicative styles.
  Communication & Medicine 01/2011; 8(2):169-80.
• Article: Response expansion as a practice for raising a concern during regular prenatal checkups.

  Aug Nishizaka
  [show abstract] [hide abstract]
  ABSTRACT: The present study addresses the issue of how pregnant women raise possible concerns in regular prenatal checkups. Within this context, the reason for the visit is not a particular problem which a pregnant woman has and would be supposed to reveal during the visit. Rather, the reason for the visit is transparent from the outset, that is, to have a prenatal checkup. However, pregnant women may have various problems that they wish to discuss with the healthcare provider. Indeed, there are various practices which pregnant women can employ to present their possible problems. In this study, I focus on a set of such practices: pregnant women expanding their responses to healthcare providers' routine questions to take initiative in presenting problems. Drawing on a corpus of 42 video-recorded regular prenatal checkups in Japan, I will elucidate structural features of the practices and their consequences.
  Communication & Medicine 01/2011; 8(3):247-59.
• Article: Combining interdisciplinary and International Medical Graduate perspectives to teach clinical and ethical communication using multimedia.

  Robyn Woodward-Kron, Eleanor Flynn, Clare Delany
  [show abstract] [hide abstract]
  ABSTRACT: In Australia, international medical graduates (IMGs) play a crucial role in addressing workforce shortages in healthcare. Their ability to deliver safe and effective healthcare in an unfamiliar cultural setting is intrinsically tied to effective communication. Hospital-based medical clinical educators, who play an important role in providing communication training to IMGs, would benefit from practical resources and an understanding of the relevant pedagogies to address these issues in their teaching. This paper examines the nature of an interdisciplinary collaboration to develop multimedia resources for teaching clinical and ethical communication to IMGs. We describe the processes and dynamics of the collaboration, and outline the methodologies from applied linguistics, medical education, and health ethics that we drew upon. The multimedia consist of three video clips of challenging communication scenarios as well as experienced IMGs talking about communication and ethics. The multimedia are supported by teaching guidelines that address relevant disciplinary concerns of the three areas of collaboration. In the paper's discussion we point out the pre-conditions that facilitated the interdisciplinary collaboration. We propose that such collaborative approaches between the disciplines and participants can provide new perspectives to address the multifaceted challenges of clinical teaching and practice.
  Communication & Medicine 01/2011; 8(1):41-51.
• Article: 'Sometimes you've just got to have fun, haven't you?': The discursive construction of social drinking practices in young adults' accounts of chronic illness.

  Benjamin Saunders
  [show abstract] [hide abstract]
  ABSTRACT: Social drinking practices have been found to be a salient issue for young adults suffering from type 1 diabetes (T1DM), and inflammatory bowel disease (IBD), with many reporting participating in such practices in spite of the potential additional health risks (Eaton et al. 2001; Balfe 2009). Drawing on interviews with sufferers of T1DM and IBD, aged 18-29 (n = 30), this paper aims to investigate how their reasoning behind this behaviour is discursively constructed. Through using the 'Accounts' framework (Scott and Lyman 1968), sufferers were shown to construct an identity of 'good' diabetic, or IBD, sufferer. A key difference found across the two conditions was that T1DM sufferers more regularly constructed 'excuses' for engaging in potentially 'risky' behaviour, whereas IBD sufferers predominantly produced 'justifications' which framed their behaviour as not necessarily being irresponsible. This finding reflects the degree of risk at which sufferers of the respective conditions view their social drinking behaviour as placing them. The stronger biomedical evidence that alcohol has negative effects on T1DM leads sufferers to view their 'healthy body' (Balfe 2009) in terms of more serious health implications, whereas IBD sufferers view their 'healthy body' in terms of short-term exacerbation of symptoms, which they do not see as significantly affecting their general IBD-health.
  Communication & Medicine 01/2011; 8(1):77-87.
• Article: Patients' narratives of chronic illnesses and the notion of biographical disruption.

  Roxana Delbene
  [show abstract] [hide abstract]
  ABSTRACT: Bury's (1982) argument that the onset of a chronic illness represents a biographical disruption has become paradigmatic in the sociology of illness studies. More recently Bury (1991, 1997) himself Williams (2000) and other medical sociologists have argued that the notion of illness as biographical disruption needs re-examination. Following a phenomenological approach, in this paper the author draws on different narrative models (Labov and Waletzky 1967 and Ricoeur 1980) to analyze how patients orient to the onset of chronic illness as the complicating action. The data comprise eight narratives collected in South America: three correspond to patients with renal failure, and five to patients with HIV/AIDS disease. It is observed that in some cases, patients' complicating actions are rather oriented to experiences of poverty, drug addiction, and criminality that took place prior to their onset of their illnesses. These experiences, instead of the onset of their illnesses, occupy the place of the complicating action in these patients' narratives. The author discusses that in the studies of illness narratives, it is difficult to operate from a different paradigm, but argues that conflating the onset of chronic illness with a biographical disruption may confuse the episodic dimension of narrative with the configurational dimension.
  Communication & Medicine 01/2011; 8(1):17-27.
• Article: 'Unilateral' decision making and patient participation in primary care.

  Taru Ijäs-Kallio, Johanna Ruusuvuori, Anssi Peräkylä
  [show abstract] [hide abstract]
  ABSTRACT: Using conversation analysis as a method, we examine patients' responses to doctors' treatment decision deliveries in Finnish primary care consultations for upper respiratory tract infection. We investigate decision-making sequences that are initiated by doctors' 'unilateral' decision delivery (Collins et al. 2005). In line with Collins et al., we see the doctors' decision deliveries as unilateral when they are offered as suggestions, recommendations or conclusions that make relevant patients' acceptance of the decision rather than their further contributions to the decision. In contrast, more 'bilateral' decision making encourages and is dependent in part on patient's contributions, too (Collins et al. 2005). We examine how patients respond to unilaterally made decisions and how they participate in and contribute to the outcome of the decision-making process. Within minimal responses patients approve the doctor's unilateral agency in decision making whereas within two types of extended responses patients voice their own perspectives. 1) In positive responses they appraise the doctor's decision as appropriate; 2) in other instances, patients may challenge the decision with an extended response that initiates a negotiation on the decision. We suggest that, firstly, unilateral decision making may be collaboratively maintained in consultations and that, secondly, patients have means for challenging it.
  Communication & Medicine 01/2011; 8(2):145-55.
• Article: Interaction order and anxiety disorder: A 'Batesonian' heuristic of speaking patterns during psychotherapy.

  Jürgen Streeck
  [show abstract] [hide abstract]
  ABSTRACT: This paper describes speaking practices enacted by young female in-patients during psychotherapy sessions. The patients are in treatment for anxiety and panic disorders (social phobias). The practices involve prosodic, lexical and pragmatic aspects of utterance construction. An effect that they share is that the speaker's embodied presence in her talk and her epistemic commitment to it are reduced as the utterance progresses. The practices are interpreted in light of Bateson's interactional theory of character formation: as elements of a self-sustaining system Angst (anxiety). The study has grown out of an interdisciplinary effort to explore possible relationships between types of anxiety and the communicative and linguistic patterns by which patients describe panic attacks and other highly emotional experiences.
  Communication & Medicine 01/2011; 8(3):261-72.
• Article: Keeping the gate ajar during openings of general practice consultations.

  Søren Beck Nielsen
  [show abstract] [hide abstract]
  ABSTRACT: A deferral of stance during the openings of general practice consultations is discussed in this paper as a possible systematic and important device for accomplishing gate keeping. The paper draws upon video recordings of naturally occurring consultations in Denmark. It is found that doctors defer their explicit stances when patients engage in a visit by requesting a specific clinical service (a prescription, a further test, a referral or a sick note etc). Instead of assuming a stance, doctors begin to ask the patients a series of questions, whilst withholding their 'yes' or 'no' throughout relatively long periods of time.
  Communication & Medicine 01/2011; 8(3):235-45.
• Article: 'Whereof one cannot speak thereof one must be silent': medical discourse and medical practice.

  Per Måseide
  [show abstract] [hide abstract]
  ABSTRACT: Significant parts of medical work are conducted as talk. In studies of medical work researchers have focused on the discursive production or mediation of medical facts. Several studies have highlighted the role of talk in many kinds of medical practice. While talk and discourse may generate medical problems and contribute essentially to medical problem solving, much of this talk is referential. It may also be used as representations in medical problem solving. In many kinds of medical practice talk deals with how to relate to clinical data, references or representations, it deals with talk itself and it deals with relations between those participating in medical work. The purpose of this paper is to show that diversity in medical discourse is grounded, not so much in the diversity of available language games but in the diversity of medical work and medical objects. Data for the article come from observations of medical team meetings in the thoracic ward of a Norwegian hospital.
  Communication & Medicine 01/2011; 8(2):181-91.
• Article: Interdisciplinary research on patient-provider communication: a cross-method comparison.

  Wen-Ying Sylvia Chou, Paul Han, Alison Pilsner, Kisha Coa, Larrie Greenberg, Benjamin Blatt
  [show abstract] [hide abstract]
  ABSTRACT: Patient-provider communication, a key aspect of healthcare delivery, has been assessed through multiple methods for purposes of research, education, and quality control. Common techniques include satisfaction ratings and quantitatively- and qualitatively-oriented direct observations. Identifying the strengths and weaknesses of different approaches is critically important in determining the appropriate assessment method for a specific research or practical goal. Analyzing ten videotaped simulated encounters between medical students and Standardized Patients (SPs), this study compared three existing assessment methods through the same data set. Methods included: (1) dichotomized SP ratings on students' communication skills; (2) Roter Interaction Analysis System (RIAS) analysis; and (3) inductive discourse analysis informed by sociolinguistic theories. The large dichotomous contrast between good and poor ratings in (1) was not evidenced in any of the other methods. Following a discussion of strengths and weaknesses of each approach, we pilot-tested a combined assessment done by coders blinded to results of (1)-(3). This type of integrative approach has the potential of adding a quantifiable dimension to qualitative, discourse-based observations. Subjecting the same data set to separate analytic methods provides an excellent opportunity for methodological comparisons with the goal of informing future assessment of clinical encounters.
  Communication & Medicine 01/2011; 8(1):29-40.
• Article: Opening up the 'black box' of the electronic patient record: a linguistic ethnographic study in general practice.

  Deborah Swinglehurst, Celia Roberts, Trisha Greenhalgh
  [show abstract] [hide abstract]
  ABSTRACT: One of the most pervasive changes in general practice is the introduction of the electronic patient record (EPR). The EPR supports both immediate clinical and anticipatory care (e.g. management of risk factors). Incorporating the EPR into social interaction is a complex task which is achieved discursively, clinician and patient responding to interactional contingencies as the consultation unfolds. Clinicians are presented with a 'dilemma of attention' as they seek to deal with the immediacy ('here and now') of the interpersonal interaction and the institutional demands ('there and then') of the EPR. We present data analysis which illuminates the EPR as an important presence in the clinic consultation context, one which places material and textual demands. Developing previous work on the triadic (three party) consultation, our novel multimodal analysis of the EPR-in-use suggests there is value in considering the EPR as a collection of silent but consequential voices. Micro-analytic attention to the way in which these different voices are managed, combined with understandings drawn from ethnographic observation of the primary care context, reveals the EPR as exhibiting a previously under-explored kind of 'agency' within the consultation.
  Communication & Medicine 01/2011; 8(1):3-15.
• Article: An exploratory study of how trust in health care institutions varies across African American, Hispanic and white populations.

  Elizabeth A Jacobs, Emily Mendenhall, Ann Scheck Mcalearney, Italia Rolle, Eric E Whitaker, Richard Warnecke, Carol Estwing Ferrans
  [show abstract] [hide abstract]
  ABSTRACT: Minority and non-minority patients in the United States have different levels of trust in health care; however, few studies have examined how determinants of trust and distrust in health care vary across diverse groups. To explore how trust in health care institutions varies across diverse populations. We conducted 17 focus groups with 117 participants in Chicago: 9 with African American, 5 with Hispanic, and 3 with white participants. Discussions were audiotaped, transcribed verbatim and coded using grounded theory analysis to identify dominant themes. We found a core set of factors that contribute to trust and distrust across racial/ethnic groups. In addition, there were unique factors that contributed to distrust among African Americans and Hispanics. Both of these groups discussed expectations of discrimination in the health care setting and African Americans discussed expectations of being experimented on as determinants of distrust. Based on these findings, we developed a hypothetical model of how different factors influence trust and distrust in health care across these different racial/ethnic groups. Contributors to trust and distrust in health care institutions are not always uniform across racial/ethnic groups. These differences should be addressed in future research and efforts to enhance trust in health care institutions.
  Communication & Medicine 01/2011; 8(1):89-98.
• Article: Multilingual interactions in clinical dental education: a focus on mediated interpreting.

  Susan M Bridges, Cynthia K Y Yiu, Colman P McGrath
  [show abstract] [hide abstract]
  ABSTRACT: In clinical dental consultations in multilingual contexts, medical interpreting is often performed by the supporting staff as part of routine triadic formulations. As academic dentistry becomes increasingly internationalized, issues of language and culture add to the interactional complexity of clinical communication and education. A multivariate approach was adopted to investigate one case of multilingualism in dentistry in Asia. Collection of both survey (n = 86) and interactional data provided empirical evidence regarding language use and language demands across integrated Polyclinics. Descriptive statistics of Dental Surgery Assistant (DSA) perception data and conversation analysis (CA) of mediated interpretation indicate that, as members of the oral healthcare team, DSAs in Hong Kong are an essential resource in their role of intercultural mediators between patients and clinicians, both staff and students. Discussion of sociolinguistic notions of place-as-location and place-as-meaning supports a wider conceptualization of the role of support staff as interpreters in clinical settings. Implications are drawn for policy, curriculum and staff development.
  Communication & Medicine 01/2011; 8(3):197-210.
• Article: The everyday elasticity of compliance in a symptomless disease.

  Lina Klara Hoel Felde
  [show abstract] [hide abstract]
  ABSTRACT: Medically, compliance refers to the extent to which a patient's response to medical advice coincides with doctors' orders. Rather than this absolute standard, this article treats compliance as an institutionally available discourse continually figured in practice. The aim of this article is to describe people's everyday elasticity of compliance in shifting contexts in everyday life. The empirical material presented, based on interviews with people with elevated cholesterol, suggests that people with symptomless diseases can be perceived to be living in a virtual 'temporal limbo', living 'here and now' in the present from one episode to the next. Present-bound conditions create, from moment to moment, a temporal limbo that challenges and conditions the participants' constructions of compliance. Using three contexts as examples, this article empirically demonstrates how people with a symptomless disease accomplish--reflexively produce and reproduce--compliance in and through shifting contexts. Compliance is ever-emerging and stretched, adapted to the circumstances at hand, ongoingly constructed through a reflexive interplay between compliance-in-practice and compliance practice in a discursive give-and-take. This elasticity of compliance reveals a reflexive critique of medical compliance as a moral standard and leads us to discuss how people are adequately compliant in everyday moral contexts.
  Communication & Medicine 01/2011; 8(2):123-34.
• Article: Non-verbal vocalizations, dementia and social interaction.

  Lars-Christer Hydén
  [show abstract] [hide abstract]
  ABSTRACT: In later stages of Alzheimer's disease many people will engage in noise-making (screaming and other kinds of sounds), often experienced as interruptive by others. A problem with the noise-making is the difficulty in understanding the meaning of the noise. This study addresses two questions: to what extent is noise-making responsive to the ongoing interaction and is noise-making regarded as meaningless behavior by other participants? The analysis of selective examples shows that noises may be fitted into the conversational interaction to a certain degree and in some instances is also responsive to interaction. The co-participants tend to treat the noises as meaningful. A general conclusion is that if utterances and responses in interaction are treated as if they are meaningful, they will become meaningful in their consequences for all participants.
  Communication & Medicine 01/2011; 8(2):135-44.
• Article: What to eat in the land of cheese and chocolate: a content analysis of Swiss print media messages on a healthy diet.

  Peter J Schulz, Uwe Hartung
  [show abstract] [hide abstract]
  ABSTRACT: This paper describes a specific coding scheme for measuring health-related media content on the level of single assertions and in relative complexity. The basic idea is to code messages into an if-part (nutrition, physical activity, body weight) and a then-part (weight and health). Detailed codeplans can then be used to determine the specific nature of the if- and then-parts of an assertion. An exemplary analysis of Swiss-German newspaper and magazine messages between March 1, 2003 and June 30, 2005 provides evidence of recommendations that are more or less in line with official suggestions for a healthy diet: Newspapers and magazines tell their readers to eat vegetables, fruit, grain and cereal products, dairy products, and to care about vitamin and minerals intake. They also advise to stay away from tobacco, alcohol, fast food, sugar, and animal fat. Results are interpreted as evidence for the existence of a rather good source for diet information in print media, which is, however, very likely to be counteracted by other media content.
  Communication & Medicine 01/2011; 8(1):99-110.
• Article: Doctors' questions as displays of understanding.

  Arnulf Deppermann, Thomas Spranz-Fogasy
  [show abstract] [hide abstract]
  ABSTRACT: Based on German data from history-taking in doctor-patient interaction, the paper shows that the three basic syntactic types of questions (questions fronted by a question-word (w-questions), verb-first (V1) questions, and declarative questions) provide different opportunities for displaying understanding in medical interaction. Each syntactic question-format is predominantly used in a different stage of topical sequences in history taking: w-questions presuppose less knowledge and are thus used to open up topical sequences; declarative questions are used to check already achieved understandings and to close topical sequences. Still, the expected scope of answers to yes/no-questions and to declarative questions is less restricted than previously thought. The paper focuses in detail on the doctors' use of formulations as declarative questions, which are designed to make patients elaborate on already established topics, giving more details or accounting for a confirmation. Formulations often involve a shift to psychological aspects of the illness. Although patients confirm doctors' empathetic formulations, they, however, regularly do not align with this shift, returning to the description of symptoms and to biomedical accounts instead. The study shows how displays of understanding are responded to not only in terms of correctness, but also (and more importantly) in terms of their relevance for further action.
  Communication & Medicine 01/2011; 8(2):111-22.
• Article: Moral accounts and membership categorization in primary care medical interviews.

  Patrick J Dillon
  [show abstract] [hide abstract]
  ABSTRACT: Although the link between health and morality has been well established, few studies have examined how issues of morality emerge and are addressed in primary care medical encounters. This paper addresses the need to examine morality as it is (re) constructed in everyday health care interactions. A Membership Categorization Analysis of 96 medical interviews reveals how patients orient to particular membership categories and distance themselves from others as a means of accounting (Buttny 1993; Scott and Lyman 1968) for morally questionable health behaviours. More specifically, this paper examines how patients use membership categorizations in order to achieve specific social identity(ies) (Schubert et al. 2009) through two primary strategies: defensive detailing and prioritizing alternative membership categories. Thus, this analysis tracks the emergence of cultural and moral knowledge about social life as it takes place in primary care medical encounters.
  Communication & Medicine 01/2011; 8(3):211-21.
• Article: To vaccinate or not? The disqualification of commercial sources of health advice in an online forum.

  Agnès Vayreda, Charles Antaki
  [show abstract] [hide abstract]
  ABSTRACT: Public health debates in online forums allow the emergence of ordinary practical reasoning about 'official' health information. We used a Discursive Psychology approach to analyse postings in a forum devoted to the discussion of the H1N1 (Swine flu) virus. We identify the discursive practices that contributors use to valorize certain elements in the debate (what they cast as science, rationality and 'proper' scepticism) over others (especially commercial interests, 'charlatanism' and 'profiteering'). A forum participant can be disqualified on the basis of their alleged partiality and interest, if they can be accused of having a commercial stake in the matter. But no such opprobrium results if they have a 'scientific' interest.
  Communication & Medicine 01/2011; 8(3):273-82.