Giving voice to the lifeworld. More humane, more effective medical care? A qualitative study of doctor-patient communication in general practice
Giving voice to the lifeworld. More humane, more effective medical care? A qualitative study of doctor-patient communication in general practice
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DOI：
10.1016/s0277-9536(00)00351-8
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发表时间：
2001-08-01
影响因子：
5.4
通讯作者：
Bradley, CP
中科院分区：
文献类型：
--
作者：
Barry, CA;Stevenson, FA;Bradley, CP
Mishler（医学的话语。医学面试的辩证法。新泽西州诺伍德：Abler）将哈贝马斯的交往行动理论应用于医疗遭遇，表明医学的声音和生活世界的声音之间的斗争如何分裂和压制患者的多方面，情境化和有意义的叙述。本文调查和批评米什勒的前提下，这导致不人道的，无效的医疗服务。使用更复杂的数据收集策略，包括病人访谈，医生访谈和转录的咨询，我们显示出更复杂的关系比从Mishlers分析。我们在35个全科实践案例研究中发现了四种沟通模式。当医生和病人都只使用医学的声音（急性身体不适）时，这对简单的单一问题（严格地说，医学）起作用。当医生和病人都参与生活世界时，更多的议程被表达出来（共同生活世界），病人被认为是独特的人（心理和身体问题）。最差的结果发生在患者使用生活世界的声音，但被忽视（生活世界忽略）或被医生使用医学声音（慢性身体不适）所阻止（生活世界阻止）的情况下。该分析支持这样一个前提，即增加对生活世界的使用有助于更好的结果，并将患者作为独特的人类进行更人性化的治疗。一些医生在不同的咨询中改变了沟通策略。这表明他们的行为可能是开放的。如果医生能够意识到处理慢性身体疾病和心理疾病患者生活世界的重要性，那么就有可能为患者提供更好的护理。这就需要关注医疗保健系统的结构方面，使医生能够充分在以病人为中心的模式下工作。(C)2001爱思唯尔科技有限公司版权所有。
Mishler (The discourse of medicine. The dialectics of medical interviews. Norwood, NJ: Abler), applying Habermas's theory of Communicative Action to medical encounters, showed how the struggle between the voice of medicine and the voice of the lifeworld fragmented and suppressed patients' multi-faceted, contextualised and meaningful accounts. This paper investigates and critiques Mishler's premise that this results in inhumane, ineffective medical care. Using a more complex data collection strategy, comprising patient interviews, doctor interviews and transcribed consultations we show more complex relations than emerged from Mishlers analysis. We found four communication patterns across 35 general practice case studies. When doctor and patient both used the voice of medicine exclusively (acute physical complaints) this worked For simple unitary problems (Strictly, Medicine). When both doctor and patient engaged with the lifeworld, more of the agenda was voiced (Mutual Lifeworld) and patients were recognised as unique human beings (psychological plus physical problems). Poorest outcomes occurred where patients used the voice of the lifeworld but were ignored (Lifeworld Ignored) or blocked (Lifeworld Blocked) by doctors' use of voice of medicine (chronic physical complaints). The analysis supports the premise that increased use of the lifeworld makes for better outcomes and more humane treatment of patients as unique human beings. Some doctors switched communication strategies in different consultations. which suggests that their behaviour might be open to change. If doctors could be sensitised to the importance of dealing with the concerns of the lifeworld for patients with chronic physical conditions as well as psychological conditions, it might be possible to obtain better care for patients. This would require attention to structural aspects of the healthcare system to enable doctors to work fully within the patient-centred model. (C) 2001 Elsevier Science Ltd. All rights reserved.