Biomedical Engineering Reference
In-Depth Information
and hence be able to understand functional problems, the doctor had to pay
more attention to the patient's symptoms; this was also important in order
to increase compliance with treatment regimes.
All these changes in medicine affect the communicative patterns and the
relationship between doctor and patient in the general area of negotiation
and dialogue. The changes have resulted in the development of new
communicative technologies and ideologies - technologies that do not
basically differ from other medical technologies in that they mediate the
relationship between doctor and patient.
One way of understanding the new communicative technologies and
ideologies is to investigate how these are learnt. Surprisingly few studies have
focused on the way medical students learn how to talk with patients - and
most studies are concerned with comparing content and educational practices
of communication skills training (Hargie et al . 1998), evaluating courses'
effects (Aspegren 1999; Hulsman et al . 1999), or identifying background
factors that enhance or hinder communicative performance (Suzuki Laidlaw
et al . 2006) or effects on communication skills (Harms et al . 2004).
Medical programmes in communication are interesting because many of
the phenomena that are integrated in daily medical practice and hence are
taken for granted are the objects of deliberation and learning during medical
education. Strategies, assumptions, norms and conventions that are part of
the everyday medical communicative practice must be made explicit during
the learning process in order for students to be able to understand and learn
to organize their own communicative practices. Hence they become visible
and possible to study and discuss.
Communicative ideologies and technologies
As we discussed above, the changes in medicine have gone from a one-sided
perspective on the inner body to an interest in a functional perspective of
the patient in his/her life-world context, resulting in an increased need for
knowledge about the patient outside the clinic. Many other factors have
also affected the relationship between medical doctor and patient. Most
of these factors have to do with the social conditions and constraints of
the health care system, like diminishing medical authority, emergence of
medical shopping and patient activism. Through these developments new
communicative needs emerge in the health care sector in general, and more
specifi cally between doctors and patients.
Due to the development of medical technology a number of new
communicative situations have emerged. This is especially true in areas where
decisions have to made and the patient has to be involved, for instance in
genetic counselling or when medical doctors or registered nurses have to
try to get the patient to make a change in lifestyle (cf. Adelswärd and Sachs
1996, 1998; Sarangi 2000; Sarangi and Clarke 2002). In most of these areas
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