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Giving voice to the lifeworld. More humane, more effective medical care? A qualitative study of doctor-patient communication in general practice

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  • Barry, Christine A.
  • Stevenson, Fiona A.
  • Britten, Nicky
  • Barber, Nick
  • Bradley, Colin P.

Abstract

Mishler (The discourse of medicine. The dialectics of medical interviews. Norwood, NJ: Ablex), applying Habermas's theory of Communicative Action to medical encounters, showed how the struggle between the voice of medicine and the voice of the lifeworld fragmented and suppressed patients' multi-faceted, contextualised and meaningful accounts. This paper investigates and critiques Mishler's premise that this results in inhumane, ineffective medical care. Using a more complex data collection strategy, comprising patient interviews, doctor interviews and transcribed consultations we show more complex relations than emerged from Mishler's analysis. We found four communication patterns across 35 general practice case studies. When doctor and patient both used the voice of medicine exclusively (acute physical complaints) this worked for simple unitary problems (Strictly Medicine). When both doctor and patient engaged with the lifeworld, more of the agenda was voiced (Mutual Lifeworld) and patients were recognised as unique human beings (psychological plus physical problems). Poorest outcomes occurred where patients used the voice of the lifeworld but were ignored (Lifeworld Ignored) or blocked (Lifeworld Blocked) by doctors' use of voice of medicine (chronic physical complaints). The analysis supports the premise that increased use of the lifeworld makes for better outcomes and more humane treatment of patients as unique human beings. Some doctors switched communication strategies in different consultations, which suggests that their behaviour might be open to change. If doctors could be sensitised to the importance of dealing with the concerns of the lifeworld for patients with chronic physical conditions as well as psychological conditions, it might be possible to obtain better care for patients. This would require attention to structural aspects of the healthcare system to enable doctors to work fully within the patient-centred model.

Suggested Citation

  • Barry, Christine A. & Stevenson, Fiona A. & Britten, Nicky & Barber, Nick & Bradley, Colin P., 2001. "Giving voice to the lifeworld. More humane, more effective medical care? A qualitative study of doctor-patient communication in general practice," Social Science & Medicine, Elsevier, vol. 53(4), pages 487-505, August.
    • Handle: RePEc:eee:socmed:v:53:y:2001:i:4:p:487-505
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    Cited by:

    1. May, Carl & Rapley, Tim & Moreira, Tiago & Finch, Tracy & Heaven, Ben, 2006. "Technogovernance: Evidence, subjectivity, and the clinical encounter in primary care medicine," Social Science & Medicine, Elsevier, vol. 62(4), pages 1022-1030, February.
    2. Hardman, Doug & Geraghty, Adam W.A. & Lown, Mark & Bishop, Felicity L., 2020. "Subjunctive medicine: Enacting efficacy in general practice," Social Science & Medicine, Elsevier, vol. 245(C).
    3. Waring, Justin & Latif, Asam & Boyd, Matthew & Barber, Nick & Elliott, Rachel, 2016. "Pastoral power in the community pharmacy: A Foucauldian analysis of services to promote patient adherence to new medicine use," Social Science & Medicine, Elsevier, vol. 148(C), pages 123-130.
    4. Leanza, Yvan & Boivin, Isabelle & Rosenberg, Ellen, 2010. "Interruptions and resistance: A comparison of medical consultations with family and trained interpreters," Social Science & Medicine, Elsevier, vol. 70(12), pages 1888-1895, June.
    5. Williams, Kevin Frank, 2007. "Re-examining 'professionalism' in pharmacy: A South African perspective," Social Science & Medicine, Elsevier, vol. 64(6), pages 1285-1296, March.
    6. Gately, Claire & Rogers, Anne & Sanders, Caroline, 2007. "Re-thinking the relationship between long-term condition self-management education and the utilisation of health services," Social Science & Medicine, Elsevier, vol. 65(5), pages 934-945, September.
    7. Weiste, Elina & Peräkylä, Anssi & Valkeapää, Taina & Savander, Enikö & Hintikka, Jukka, 2018. "Institutionalised otherness: Patients references to psychiatric diagnostic categories," Social Science & Medicine, Elsevier, vol. 207(C), pages 71-79.
    8. Daker-White, Gavin & Rogers, Anne & Kennedy, Anne & Blakeman, Thomas & Blickem, Christian & Chew-Graham, Carolyn, 2015. "Non-disclosure of chronic kidney disease in primary care and the limits of instrumental rationality in chronic illness self-management," Social Science & Medicine, Elsevier, vol. 131(C), pages 31-39.
    9. Doblytė, Sigita, 2022. "The vicious cycle of distrust: Access, quality, and efficiency within a post-communist mental health system," Social Science & Medicine, Elsevier, vol. 292(C).
    10. Martin, Graham P. & Chew, Sarah & Dixon-Woods, Mary, 2021. "Why do systems for responding to concerns and complaints so often fail patients, families and healthcare staff? A qualitative study," Social Science & Medicine, Elsevier, vol. 287(C).
    11. Lo, Ming-Cheng Miriam & Bahar, Roxana, 2013. "Resisting the colonization of the lifeworld? Immigrant patients' experiences with co-ethnic healthcare workers," Social Science & Medicine, Elsevier, vol. 87(C), pages 68-76.
    12. Ariss, Steven M., 2009. "Asymmetrical knowledge claims in general practice consultations with frequently attending patients: Limitations and opportunities for patient participation," Social Science & Medicine, Elsevier, vol. 69(6), pages 908-919, September.
    13. Murdoch, Jamie & Salter, Charlotte & Ford, John & Lenaghan, Elizabeth & Shiner, Alice & Steel, Nicholas, 2020. "The “unknown territory” of goal-setting: Negotiating a novel interactional activity within primary care doctor-patient consultations for patients with multiple chronic conditions," Social Science & Medicine, Elsevier, vol. 256(C).
    14. Jennifer Watermeyer & Victoria Hume & Tshegofatso Seabi & Bruno Pauly, 2020. "“It’s got its own life, and you can’t contain it”: A qualitative study of patient and health professional experiences of diabetes care," Journal of Clinical Nursing, John Wiley & Sons, vol. 29(1-2), pages 240-250, January.
    15. Lynch, Johanna M. & Askew, Deborah A. & Mitchell, Geoffrey K. & Hegarty, Kelsey L., 2012. "Beyond symptoms: Defining primary care mental health clinical assessment priorities, content and process," Social Science & Medicine, Elsevier, vol. 74(2), pages 143-149.
    16. Sarah Jane Brubaker, 2024. "Toward a Critical Sociology of Campus Sexual Assault: Victim Advocacy as the Lifeworld Resisting the System," Social Sciences, MDPI, vol. 13(3), pages 1-16, February.
    17. Fudge, Nina & Swinglehurst, Deborah, 2022. "Keeping in balance on the multimorbidity tightrope: A narrative analysis of older patients’ experiences of living with and managing multimorbidity," Social Science & Medicine, Elsevier, vol. 292(C).

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