Communicating about health in health care : Perspectives on life style and post-operative complications

Abstract: This study, which is exploratory in nature, has been conducted with the aim of uncovering patients' participation and co-operation in modern health care and analysing what the conditions of this co-operation look like. Another aim has been to enhance knowledge about institutional discourse on a general level as well as about dialogues between patients and physicians concerning life style issues at a more specific level. Byanalysing the contributions of patients and professionals to written and oral communication produced in health care, the intention has been to study differences in how patients and professionals talk about and interpret issues of health in consultations as well as in their evaluation of health care measures. Another problem concerns the attention given tolife style in primary health care dialogues and how such issues are discussed and utilised by the interlocutors; for example, how knowledge of life style generated in the encounter is used as a resource for improving patient health status.In the theoretical background, it is argued that institutional encounters can be seen as discursive practices involving people who vary in communicative power and expertise. Furthermore, this kind of complex setting is in many ways a characteristic of modern society. The dominance of professionals, who represent specific knowledge, can be seen as a manifestation of the discourse in health care, and it is to this discursive regimen that patients as well as physicians adhere.The thesis is based on three projects which have generated four substudies included in this thesis. Three of the studies focus on patient-professional communication about life style issues, where the empirical data consist of 42 authentic consultations with physicians at two primary health care centres. The consultations as well as the subsequentinterviews with patients and physicians, respectively were audiorecorded. The recorded material was transcribed and, furthermore, the notes in the medical records were collected. The fourth study concerns perceptions of complications among patients and health care staff. The data concerning the patients' view have been collected using a threemonth follow-up questionnaire. Data concerning complications have been registered byprofessionals during hospitalisation.Throughout the four studies, the differences between patients' and professionals' perspectives are clearly visible, findings which corroborate the existence in institutionalised medical practice of distinct differences between the 'voice of medicine' and a the 'voice of the life-world'. As regards patients' participation and co-operation in health care, dialogues on life style show. that the patients and the physicians shared the discourse space equally, although, in the literature about doctor-patient communication, physicians have generally been shown to be quite dominant during consultations. The results from the different substudies show, however, that communication about life style is used for many purposes. Despite the frequent talk of life style issues, the physicians seem not to use the educational potential at hand in order to improve the patient's knowledge about possible relationships between different life style issues and the patient's health condition. This issue, amorig others, is discussed in the light of modern society as a society of 'choices' and 'risks'. Hence, the distribution· of knowledge becomes especially important in a risk society where health and medical knowledge has become the main instrument for determining risks.