Handbook of Health Communication

By Teresa L. Thompson; Alicia M. Dorsey et al. | Go to book overview

4
Communication in Medical
Encounters: An Ecological
Perspective
Richard L. Street, Jr.
Texas A&M University

Has managed care made it harder for patients and physicians to talk openly and honestly with one another? Has the Internet changed the way patients communicate with their doctors? What effect are new state and federal health policies (e.g., patient bills of rights) having on the health care provider–patient relationship? To what extent do race and ethnicity affect decisions made during medical consultations? These are but a few of the questions currently being asked by a variety of stakeholders of the health care system, including policymakers, managed care corporations, health care providers, patients, and media pundits, to name a few. Those of us who study health communication should be both encouraged and troubled by these questions.

On the one hand, they highlight the centrality of communication in the delivery of quality health care. On the other hand, despite over 40 years of research, we still do not know enough to adequately explain how a changing health care landscape is transforming the communicative dynamics of medical consultations. The primary shortcoming in our work is that, whereas we have examined provider–patient communication with respect to the participants' characteristics and skills, we have done relatively little to develop and test theoretical models of the processes underlying these interactions, nor have we directed sufficient attention toward explaining the role of context in the medical encounter (Thorne & Paterson, 2001).

In this chapter, I present an ecological perspective for the study of communication in medical encounters. Ecology, simply defined, is the study of interrelationships between organisms and their environments. An ecological perspective on communication in the medical consultation, then, looks at the interaction between health care providers and patients as situated within and affected by a variety of social contexts. This chapter places extant research within the framework of an ecological model in an effort to explain key

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