Jännitteet lääkärin ja potilaan välisessä viestintäsuhteessa

Abstract

The purpose of the present study is to explore tensions in doctor-patient communication from a theoretical and an empirical point of view. Communication in the doctor-patient relationship is by its very nature tensional. Further, it is likely give rise to misunderstandings and ambiguity. The theoretical framework of the study combines three perspectives: a) Zygmunt Bauman's view on love or gift and exchange as extreme and main motives of social relationships causing tension especially in those relationships which involve both role-based and personally-based elements, such those as between a doctor and a patient. b) relational dialectics developed by Leslie Baxter and Margaret Montgomery which receives the greatest emphasis in the study. c) the ideas presented by Michael Billig et al. on the problematic nature of expertise in human relations which is shown in oscillation between the impersonality of the medical expert and the equality of the friend. These theoretical approaches form the dialectical frame of reference for the study of doctor-patient communication and relationship. Based on the earlier research on relational dialectics and an analysis of the data the following relational tensions were identified: dialectic of relational closeness-distance, expressiveness-protectiveness or privacy, autonomy-interdependence, predictability-surprise and judgement-acceptance. The study describes empirically how each of the identified relational tensions is manifested or constructed in the doctor-patient relationship. The empirical data consists videotaped medical encounters (n=26) and tape-recoded interviews with doctors (n=5) as well as patients (n=25) The dialectical framework is regarded as a relevant basis for the study of the doctor-patient communication because it gives room for taking notice of the different meanings of communication procedures and features without regarding some of them as self-evidently negative or things to be avoided. Further, the dialectical framework, with relational dialectics in its core, is treated as a general social theory through which doctor-patient communication and relationships can be extensively examined.