Biomedical Engineering Reference
In-Depth Information
of situations in which medical doctors investigate not only the inside of the
body, but also the social and moral spaces in which bodies live. They do
this in order to suggest a diagnosis and treatment (coronary diseases), help
the patient to change his or her life (stop smoking) or make vital decisions
(genetic counselling). The medical doctor has to be able to use and elicit all
the various types of information that are medically needed and contribute
information to individuals and families in order to help them make decisions.
This means that medical doctors have to be able to talk with almost all kinds
of patients in various medical contexts.
Formalizing certain basic interactional strategies as communicative skills
and part of a communicative ideology makes it possible to learn, practise
and account for these skills. But learning to communicate with patients also
means changing attitudes towards oneself and others, and especially towards
medical colleagues.
We illustrate and exemplify this development by using examples from
a study of the long-term course in medical communication that is part of
the educational programme for medical doctors at a Swedish university. We
especially want to illustrate the ways medical students acquire a
professional
way of communicating with patients, and show what problems they encounter
and which coping strategies they employ. That is, we want to show how they
learn to implement and use the communicative technology and ideology
taught during their medical training courses, and the effect this practice has
on their identities as medical doctors.
The changing medical fi eld
The relationship between medical doctor and patient and the norms and ideals
that guide and control this relationship are affected by a host of conditions
both internal and external to medicine. These include the development of
new medical technologies (Conrad 2005), changes having to do with the
position of patients
vis-à-vis
the medical system, political activism among
patients, and market-place competition and consumerism (Conrad and
Leiter 2004; Mechanic 2002; Williams and Calnan 1996). But it also has to
do with changes in the general medical world-view, i.e. how patients, bodies,
diseases and treatments are perceived and considered.
The British medical sociologist David Armstrong has pointed out that at
least from the early 1900s until the early 2000s medicine defi ned the body
primarily through its three-dimensionality (Armstrong 2002). Diseases had
their sites inside the body, in specifi c organs, structures and functions. For
the medical doctor it was of great importance to be able to look into the
body in order to be able to observe and understand lesions and pathologies.
Basically this could be done in two ways. It could be done through the
interpretation of signs and symptoms, or by using various techniques and
instruments in order to
look
inside the body. Simple technological devices
like the stethoscope and techniques like palpation made it possible to listen
