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• W3151136697 abstract "The communication of information between patient and physician is a difficult and often flawed undertaking. Although the patient may be more immediately aware of dissatisfaction with the results, the presence of incomplete or inaccurate information will ultimately affect the physician’s ability to function and the quality of care he can deliver. This is an especially important problem in chronic tllness where the social, psychological and environmental factors which may impinge on the illness often cannot be identified or verttied by laboratory tests. The physician’s need to maintain control and hence power over the patient has been suggested as an explanation for these communication difhculties. This paper examines how the home setting influences phystcian control by including information about the patient and his disease which the clinic context actively excludes. It argues that the loss of control which physicians experience affects communication between patient and physician and thus the quality of information obtained in that communication. and further that the information gathered is important in the care of the Ion g term chronically ill patient. This article examines the influence of setting on patient-physician communication. It will analyze the impact of a non-clinical setting-the home-on the control physicians traditionally exercise over that communication. I will be concerned not only with a systematic explication of the role of context but will also argue that the nature of information which emerges from this communication is particularly salient in the long term management of the chronically ill patient. COZlTROL .ASD CO~i~ItiNICATION It is well established that within the clinical context physicians exert control over communication with their patients. This is done in many ways, i.e. through body language [I] or the use of technical jargon [2]. There are several explanations for this dynamic. Cartwright [3] argues that it results from a difference in social status. Parsons [4] hypothesizes that the exercise of control is necessary for the physician to maintain power over the patient. Access to information about another is one mark of power [j] and the asymmetry between professional and lay understandings of disease creates an inherently differential access to information. Such power is believed to have a therapeutic logic. the less said the more all knowing the physician appears and hence may be invested with a symbolic power to heal. Fox [6] developing Parson’s theories posits a more pragmatic explanation. She argues that the practice of medicine involves a considerable amount of uncertainty. Control over information may serve as a talisman obfuscating the physician’s uncertainty and assuring physician and patient alike of the physician’s ultimate power over his disease. Such control also. according to Emerson [7]. helps maintain a face-saving distance in potentially embarrassing clinical encounters. such as the gynecological examination. Yet this control also seriously inhibits the flow of information and often leads to patient dissatisfaction [S]. Because control appears to be so embedded in the dynamics of patient-physician communication. its loss, when such occurs. is sharply noticeable to physicians. sometimes to the point of engendering consternation. Its loss also, as vve shall see, has important implications for treatment. In a study designed to assess the effects of a home visiting experience on medical students’ attitudes toward the chronically ill elderly, informants’ responses consistently centered around the issue of control, its loss and the effect such a loss had on treatment and on the physician’s relationship with their patient. The ‘loss of control’ which is how many students chose to describe the experience affected their perceptions of themselves as physicians, of the appropriateness of their role. of chronic illness, and their attitudes toward elderly patients." @default.
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• W3151136697 date "2002-01-01" @default.
• W3151136697 modified "2023-09-27" @default.
• W3151136697 title "OUT OF THE CLINIC INTO THE HOME: CONTROL AND PATIENT-PHYSICIAN COMMUNICATION" @default.
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