The communication process in clinical settings

https://doi.org/10.1016/0277-9536(83)90197-1Get rights and content

Abstract

The communication of information in clinical settings is fraught with problems despite avowed common aims of practitioners and patients. Some reasons for the problematic nature of clinical communication are incongruent frames of reference about what information ought to be shared, sociolinguistic differences and social distance between practitioners and patients. Communication between doctors and nurses is also problematic, largely due to differences in ideology between the professions about what ought to be communicated to patients about their illness and who is ratified to give such information.

Recent social changes, such as the Patient Bill of Rights and informed consent which assure access to information, and new conceptualizations of the nurse's role, warrant continued study of the communication process especially in regard to what constitutes appropriate and acceptable information about a patient's illness and who ought to give such information to patients.

The purpose of this paper is to outline characteristics of communication in clinical settings and to provide a literature review of patient and practitioner interaction studies in order to reflect on why information exchange is problematic in clinical settings. A framework for presentation of the problems employs principles from interaction and role theory to investigate clinical communication from three viewpoints: (1) the level of shared knowledge between participants; (2) the effect of status, role and ideology on transactions; and (3) the regulation of communication imposed by features of the institution.

References (78)

  • J. McIntosh

    Processes of communication, information seeking and control associated with cancer

    Soc. Sci. Med.

    (1974)
  • V. Francis et al.

    Gaps in doctor-patient communication: patients' responses to medical advice

    New Engl. J. Med.

    (1969)
  • J.A. Wolfer et al.

    Assessment of surgical patients' pre-operative emotional condition and post-operative welfare

    Nurs. Res.

    (1970)
  • A. Cartwright

    Human Relations and Hospital Care

    (1964)
  • P. Boreham et al.

    The informative process in private medical consultations: a preliminary investigation

    Soc. Sci. Med.

    (1978)
  • P.L. Berger et al.

    The Social Construction of Reality

    (1966)
  • H. Garfinkel

    Studies in Ethnomethodology

    (1967)
  • A. Cicourel

    Interviewing and Memory

  • J. Gumperz

    Sociocultural knowledge in conversational inference

  • E. Goffman

    Encounters: Two Studies in the Sociology of Interaction

    (1961)
  • E. Goffman

    Behavior in Public Places

    (1963)
  • E. Goffman

    Interaction Ritual. Essays in Face-to-Face Behavior

    (1967)
  • H. Sacks et al.

    A simplest systematics of turn taking for conversation

    Language

    (1974)
  • C. Cherry

    On Human Communication

    (1978)
  • C. Cherry

    On Human Communication

  • W.F. Whyte

    Organization behavior research

  • W.F. Whyte

    Organization behavior research

  • W.H. Goodenough

    Rethinking ‘status’ and ‘role’: toward a general model of the cultural organization of social relationships

  • H. Garfinkel

    Studies in the routine grounds of everyday activities

  • M. Weber

    The Theory of Social and Economic Organization

    (1947)
  • E. Goffman

    Asylums

    (1961)
  • E. Goffman

    Asylums

  • E. Goffman

    Asylums

  • B.M. Korsch et al.

    Gaps in doctor-patient communication: doctor-patient interaction and patient satisfaction

    Pediatrics

    (1968)
  • B.M. Korsch et al.

    Doctor-patient communication

    Scient. Am.

    (1972)
  • R.L. Coser

    Life in the Ward

    (1962)
  • R.S. Duff et al.

    Sickness and Society

    (1968)
  • D. Bain

    Doctor-patient communication in general practice consultations

    Med. Educ.

    (1976)
  • D.A. Pendleton et al.

    The communication of medical information in general practice consultations as a function of patients' social class

    Soc. Sci. Med.

    (1980)
  • J.C. Quint

    Institutionalized practices of information control

    Psychiatry

    (1965)
  • A. Cicourel

    Language and medicine

  • J.A. Roth

    Information and the control of treatment in tuberculosis hospitals

  • F. Davis

    Passage Through Crisis: Polio Victims and their Families

    (1963)
  • J.K. Skipper

    Communication and the hospitalized patient

  • E. Freidson

    Professional Dominance

    (1970)
  • J.K. Skipper

    Communication and the hospitalized patient

  • C. Taylor

    Horizontal Orbit: Hospitals and the Cult of Efficiency

    (1970)
  • L. Goodwin et al.

    Doing away with the “doctor-nurse game”

    Supervisor Nurse

    (1977)
  • Cited by (72)

    • Multilevel Approach to Support Diversity, Equity and Inclusion in Radiology

      2023, Academic Radiology
      Citation Excerpt :

      For example, various authors have cited race and ethnicity as important cultural barriers in patient-physician communication (26–29). Problems in communication arising from the cultural differences between the patients and the physicians often contribute to differences in understanding the cause, treatment and outcome of a disease process or to finding alternative solutions (30,31). Several published papers have shown better health outcomes when improved cross-cultural communication and access to a diverse physician group is provided (32).

    • Men and differences by racial/ethnic group in self advocacy during the medical encounter

      2010, Journal of Men's Health
      Citation Excerpt :

      Perceived mistreatment is associated with poorer medical adherence and delays in seeking health care [11]. Some of the interactions between the physician and patient can be attributed to race, culture, and social class [12–14]. The amount of information to discuss or withhold from a patient is related to physicians response to culture [13], social class, and race of patient [12,14].

    • Community Perspectives of Childhood Behavioral Problems and ADHD Among African American Parents

      2007, Ambulatory Pediatrics
      Citation Excerpt :

      Open discussion of treatment options and shared decision making are crucial strategies to building a therapeutic relationship between medial professionals and families. A growing body of research shows that patient-provider participatory decision-making styles correlate with increased patient satisfaction.26–29 Increasing providers’ awareness of and familiarity with community attitudes may improve physician-patient communication with promise to optimize management of behavioral problems and ADHD in children, reduce disparities in care, and improve long-term outcomes.

    View all citing articles on Scopus
    View full text