How Multiple Modes of Interaction Affect Patients and Clinicians: Participation, Authority, and Understanding in a Geriatric Medical Consultation

• Objectives: To extend the theoretical and empirical understanding of the interactional construction of authority and participation in geriatric medical and care consultations. To identify information resources and patterns of patient – clinician interaction that support geriatric patients’ understandings of and decisions about their health care treatments.Methods: This article is a case study from a research project entitled- Consultation encounters at a geriatric clinic – A study of communicative praxis. The larger project included forty (N=40) clinical consultations involving twenty-three patients, aged 65–90, and thirty-three clinicians (some consultations included two or more clinicians). The consultations at a Swedish university hospital were video recorded, and an interview with each patient was audio recorded subsequent to her or his consultation(s). Ten of the clinicians who participated in the recorded consultations volunteered to be recorded individually viewing and discussing their respective consultations. The case analyzed here involves consultation interaction between a patient and a pharmacist regarding the patient’s use of an inhaler, a device used to take medication at home. The recorded data are examined using methods developed to analyze interaction, conversation, and discourse. Findings: The data analysis shows how a combination of verbal, visual, tactile, and embodied information contributes to a patient’s participation and authority during a consultation. The various types of information support patterns of interaction that contribute both to the patient’s understanding of information presented by the pharmacist and to the pharmacist’s assessment of the patient’s understanding of information presented by the patient. The data analysis also explicates the components of consultation interaction that address key concerns of the pharmacist and patient. For the pharmacist, those concerns include presenting and assessing the patient’s understanding of information about using an inhaler to deliver medication.Conclusions: Interaction involving verbal, visual, embodied, and tactile activities supports patient participation and authority during clinical consultations in ways that provide the patient with information, which clarifies the clinician’s initial explanation. Such interaction also provides the clinician with unelicited information about the patient’s physical capabilities and living situation that are relevant to use of the inhaler and other prescribed treatments.Practice implications: Providing multiple modes of information in consultations supports patterns of interaction that express information beyond that initially offered by a clinician. Patients can apply such information to understandings of medical treatment and decision options concerning that treatment. This case provides an example of aspects of a type of patient-clinician interaction that can be more widely applied to increase geriatric patients’ authority and participation in their healthcare. 

Ämnesord

SAMHÄLLSVETENSKAP  -- Sociologi (hsv//swe)

SOCIAL SCIENCES  -- Sociology (hsv//eng)

Nyckelord

clinical consultations

geriatric patients

patient-clinician communication

patient participation

patient education

power in clinical consultations

Geriatrics

Geriatrik

Publikations- och innehållstyp

ref (ämneskategori)

art (ämneskategori)