Medical as a discourse community
"Research
on interaction in medical encounters has moved from a framework that assumed a
static and institutional asymmetry between providers and patients"
(Barton, 2000). Ellen Barton focuses on, " the situated nature of two
intertwined dimensions of the context of medical encounters-expertise and
compliance within the interactional practices of referrals and accounts of
referrals between medical professionals and families" (Barton, 2000). In
this research study I will study medical as a discourse community, meaning the
language usage a physician (expert) uses when speaking to a patient opposed to
how the physician (expert) speaks to the family. Within this research study I
will focus on how the patient feels about how the physician talks to the
patient versus family. Whether the patient has compliance versus non-compliance
with what the physician (expert) requires.
In
this research study, the relationship between Barton's study and this research
study is both focus on the compliance and non-compliance of what the physician
(expert) requires the patient to follow. Although I will use Barton's research
study, this research study will focus from an adult, the patient's point of
view opposed to a parental view regarding a child as the patient.
Ellen Burton's research study focuses on,
"specifically on families who have a child diagnosed with a disability,
and investigates a number of settings within this experience," (Barton,
2000). Within this research study I will focus on an adult patient with a
medical condition known as Lupus, focusing on her point of view of the way the
physician speaks to her (as the patient) opposed to the way the physician
speaks to the patient's family. I will focus on compliance and non-compliance
of the patient with the physician's requirements.
"In
medicine, compliance and non-compliance are technically defined in behavioral
terms as, "the extent to which a person's behavior coincides with medical
or health advice" (Barton, 2000). According to Barton, "Often-cited
examples of compliance and non-compliance in the medical literature include
taking medicine, attending appointments, following dietary restrictions,
performing self-examinations, etc." (Barton, 2000).
Within
this research study, compliance will be focused on the patient's communication
with the physician, taking the required medication and procedures that the
patient undergoes every time due to her medical condition. "When patients
were asked what aspect of the interaction had the most influence in increasing
their compliance behavior, most stated that it was having someone take the time
to talk to them, answer their questions and consider their concerns"
(Barton, 2000).
"Discourse
is assumed to be designed and shaped to occur in particular sequential and
social contexts" (Barton, 2000). "When physicians make a referral,
their medical expertise provides them with a coherent model of the various
specialties and their domains" (Barton, 2000). Within this research study
the patient was referred to a Hematologist and then the Hematologist referred
the patient to a Gastroenterologist, who performs Endoscopy's. Each specialist
performs tasks that are within their area of expertise.
“Non-compliance, then, seems to be a contextual
dimension of major importance: its discovery affects the interaction by
triggering asymmetrical dominance by the medical professional in pursuit of
accepted standards of medical care for the child,” (Barton, 2000). Not only is
this research study focusing on compliance, non-compliance as well. With an
adult patient, who is able to make decisions on her own, there are times due to
the circumstances of the medical condition; the patient is often non-compliant
to certain treatments given by the physician.
“Although
the discovery of non-compliance holds significant consequences for the
interaction between physicians and families, the situated discovery of a
family’s lack of expertise also affects the course of interaction in medical
encounters” (Barton, 2000). Within this research study, the patient had some
encounters with her physician of being non-compliant when the physician kept
insisting on the patient to continue taking a certain medication for a specific
treatment. In this case the patient was non-compliant because of the side
effects that she was feeling from that particular medication. According to Barton, “ … if the
non-compliance may be unintentional, as in…the physicians interaction and
actions become more authoritative, as the family which has displayed its lack
of expertise is turned over to the clinic staff” (Barton, 2000).
Methods
Within this research study I conducted two interviews with
an adult patient with a medical condition known as Lupus and her point of view
of how her physician speaks to her (as a patient) opposed to how the physician
speaks to the family. I will also focus on whether the patient has compliance
or non-compliance when it comes to the physician’s regimen, requirements for
treatments. The two interviews that I conducted each were thirty minutes long. Asking
questions regarding her medical condition and her perspective on how her
medical condition changed her being from the beginning of being diagnosed with
the condition to how it evolved into what it is now. Focusing on when she was
compliant to her physician’s requirement and when she was non-compliant as
well. I also conducted an ethnographic study, which I observed the patient in a
Hematologist’s office while doing her weekly blood count. The ethnographic
study was twenty-five minutes long. “Ethnographic field research involves the
study of groups and people as they go about their everyday lives,” (Emerson,
1995).
In this research I will analyze the subcategories that
are part of compliance and non-compliance. I will analyze Agency and Conflict,
the two set of stories that came about within my subject’s responses to my
interview questions. The ethnographic
study was conducted by observations and writing things down that were happening
within the Hematologist’s office among two nurses and my subject.
* This is what I have so far, I'm still working on it, I hope I'm on the right path*
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