Discourse Means of Jointly Produced Asymmetry and Symmetry in Physician-Patient Communication
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2002-07-01
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Abstract
Studies have found that during medical interview physicians tend to dominate the conversation through questioning, controlling topic and topic development, and interrupting and disregarding patients' contributions to the conversation (Hyden and Mishler 1999). Other studies have demonstrated how important a thorough knowledge of patient's psychosocial circumstances is for determining the causes and subsequent treatment of illness (Waitzkin 1991; Hyden and Mishler 1999). Thus, it is important to allow the patient to be heard in medical encounters. As part of the medical encounter, "patients and physicians both have discourse recourses upon which they draw in seeking control over the encounter and over the plan of treatment" (Ainsworth-Vaughn, 1994).
This thesis seeks to contribute to discourse analysis research on how power asymmetries are located in conversations between physicians and patients. As a consequence of the different views and positions of physicians and patients, there can be a battle of voices between "the medical view" and the "view of the lifeworld." What is more, as a consequence of the shared expectations about their respective roles, patients might not "introduce new topics or ask questions even when physicians seem to give them permission to do so" (Heath 1992 in Mishler 1999:79). There is an asymmetry in physician-patient communication that is the result not simply of one-sided discourse production, but also of the participants' jointly produced conversational strategies.
Although many studies have focused on analysis of one or two discourse moves and their resulting affect on asymmetry or symmetry, I concur with Ainsworth Vaughn's (1998) emphasis that many discourse moves can be used to consolidate power. This paper therefore explores many discourse moves of asymmetric interactions between physicians and their patients and the role that each play in this dissonance. However, these discourse moves may have multiple meanings and the interpretation of power is very complex (Ainsworth-Vaughn 1998).
Ainsworth-Vaughn (1998:43) further writes, "participants' personal, social, and professional histories are brought into the event and serve as bases for the power negotiation that takes place there." Consequently, I provide an overview of research on discourse moves and their affect on asymmetry and symmetry in encounters. I also review in more detail one particular high-level asymmetry factor, that of gender. Yet, the results of my analysis provide an interesting look at other power differences, besides gender, that come into play.
Samples of physician-patient discourse were analyzed in the context of discourse analysis to highlight areas where both asymmetry and symmetry are located. My results reflect Ainsworth-Vaughn's (1998) conclusion that "each medical encounter is a micropolitical achievement" in which the prejudices of the institution, society, and individuals shape the form of the doctor-patient encounter. The high-level asymmetry of the context takes shape in the asymmetry of the words and the conversation, which in turn reproduce and reinforce the asymmetry of the context. However, the results in my 4 samples showed race and socioeconomic status playing a more important role than gender in producing asymmetry. Thus, it seems there is some hope that certain power differences can be overcome.
In conclusion, I summarize ways in which doctors can redress asymmetry and patients can promote symmetry in order to effectively shift this typically asymmetrical relationship. However, I also discuss the many barriers to achieving an egalitarian conversation within the medical encounter. And, I propose areas for future research that could aid in more equality in the doctor-patient relationship, leading to better health and satisfaction in life.
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doctor-patient communication asymmetry
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Degree
MA
Discipline
English
