Biomedical Engineering Reference
In-Depth Information
Communication in the clinical encounter
As we have already mentioned, the clinical encounter is the medium through
which the medical technology is experienced by the individual. Traditionally,
most of the research on communication between patients and medical
practitioners has focused on the medical interview, especially interviews in
general practice (Atkinson 1995; Hydén and Mishler 1999). This may be
natural due to the fact that probably most encounters between patients and
medical professionals take place in general practice, and that this is the type
of encounter that most people are involved in. Studies of communication
have thus largely focused on the prototypical encounter in general practice
and on the dialogue between 'the doctor' and 'the patient' (ibid).
However, clinical practice has changed, not least due to the development of
medical technology, and so have the conditions for communication between
the different parties involved. These changes have to do with, among other
things, new divisions of tasks between primary health care and specialized or
hospital-based clinical practice. The development of, for example, methods
for various types of screening, as well as new non-invasive examinations,
have made it possible to carry out more 'advanced' tasks on patients on a
regular basis in primary health care. Also, medical knowledge has, as a result,
become even more specialized, and hosts different specialized professions in
addition to the medical doctor, such as the laboratory assistants, specialists
in physics, etc., who have increasingly become important in medical work.
As a consequence, communicative co-ordination between different medical
specialists, and also paramedical staff, is needed in medical work. Also team
organization, bringing various professions together in clinical work with a
joint clinical goal, has become more common in medical work, leading to
more complex forms of communication (especially talk in groups, see for
instance Linell 1998).
Through the changes in medical technology, as well as in the professional
organizations and tasks, the relationship between practitioners and
patients has become more complicated and organizationally mediated.
The relationship between the individual patient and the individual doctor,
and traditional dyadic forms of communication, is replaced with multiple
relations: between those parts of the patient's body that are represented by
technology, such as a lab sample or an X-ray image, and between various
medical professionals encountering and analysing these representations. Paul
Atkinson argues that the patient's 'body is dispersed through multiple sites
of investigation throughout [the] organizational complexity' of the modern
hospital (Atkinson 1995: 61). To this could be added that the medical
profession as well is dispersed throughout the organizational complexity
resulting in multiple relations between the patient, his or her body and
various specialized professionals. Some of these relations are instantiated
as actual face-to-face encounters, others take place in cyberspace or inter-
professional conversations with the patient as the absent-present 'Third'.
