Academic journal article The Qualitative Report

"Dr. Right": Elderly Women in Pursuit of Negotiated Health Care and Mutual Decision Making

Academic journal article The Qualitative Report

"Dr. Right": Elderly Women in Pursuit of Negotiated Health Care and Mutual Decision Making

Article excerpt

Introduction

Strauss and Corbin (1990) contend that each researcher brings to an inquiry a considerable background in professional and disciplinary literature. To be more open to the kind of communications that elderly women have with their physicians, a brief review of some articles about elderly women and their interactions with physicians was conducted prior to the research. An additional literature review was conducted at the study's conclusion, relevant to theories and research about physician-patient interactions. The review before the study helped to avoid viewing the participants' interviews through a single prescribed lens.

In this article, we examine a group of elderly women's perceptions of their interactions with their primary care physicians. Having worked as radiographers, collecting diagnostic information allowed us to become familiar with older women's chronic health issues and options for health care. Our academic preparation made us familiar with published works that dealt with patient communications that provide a medical diagnosis and treatment. Professionally, it has been advocated that the best treatments for women result from careful discussions occurring with various experts during the diagnosis and the treatment phases of care (Bergsma & Thonmasma, 2000). Complicating these communications is the fact that women of advanced age have a propensity for suffering from more than one chronic disease (Wilcox & Stefanick, 1999). This can complicate a discussion about best treatment options, since elderly women have multiple concerns and need detailed descriptions of various treatment options. This often results in time consuming and complicated conversations, which can be misinterpreted by physicians as being characterized as the patient being indecisive (Makuc, Freid, & Kleinman, 1989).

Elderly women have reported being intimidated prior to and during their physician's visit. Some of this apprehension might be related to a struggle for clearly articulating their health care concerns. Unfortunately, this anxiety can be heightened due to a physician's tendency to impart her/his knowledge and recommendations through a one-way style of communication (Ishikawa et al., 2005).

Previous studies have focused on examining a one-way style of communication that is hallmarked by either the physician or patient communicating without concurrent discussion (Hall, Roter, & Milburn, 1996; Jenkins, 2003; Marek, Popejoy, & Petroski, 2005; McKinlay, Burns, & Feldman, 1998; Quill, 1983, 1989). These studies have documented that a one-way physician-patient communication has the tendency to exclude the patient from the decision process. One-way interactions between patients and physicians have been addressed by trying to sensitize medical students to the need to listen more carefully to their patients.

This is not an insignificant problem, as persons over the age of 85 in the United States will increase in number by a factor of five in the next 50 years (Bergsma & Thonmasma, 2000). As this significant group of health care consumers search for a physician-patient relationship, they are interested in a relationship that honors their values and ability to make informed decisions. The literature supports the fact that women are more likely to find a desirable physician by "word of mouth." Endorsements provided by other people, neighbors, family members, and current patients have been reported to provide better than a 50% influence on the selection of a new physician (Goodman, 1999).

The fundamental focus of this study was to describe and analyze the types of interactions that elderly women experienced with their physicians. We began this exploration by trying to discover what types of health concerns had developed in a group of elderly women living in a retirement community. The next part of this study was to allow the women to discuss their options for handling chronic health conditions. …

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