Identity and discourse : a critical philosophical investigation of the influence of the intellectual self-image of the medical profession on communicatively effective care to patients

Gerber, Berna (2013-12)

Thesis (PhD)--Stellenbosch University, 2013.

ENGLISH ABSTRACT: Communication between doctors and patients in clinical settings is notorious for being difficult. This problem has inspired a wealth of empirical research from a variety of academic fields on the subject of doctor-patient communication. However, very little attention has been paid to the role of modern medicine's intellectual self-image as natural science in interactions within clinical medical settings. The aim of the current study was to philosophically investigate the influence of the medical profession's intellectual self-image on communication between doctors and patients. Jürgen Habermas' work on Universal Pragmatics was used to comment on doctor-patient communication as it is described in the existing empirical research literature. Michel Foucault's work on discourse and power was used to analyse and describe medical discourse and the nature of power in doctor-patient relationships. The outcome of this philosophical analysis leads to the conclusion that modern medicine's intellectual self-image has a pervasive and negative influence on communication between doctors and patients during clinical consultations. This is because medicine's positivist world-view results in an almost exclusive focus on the physical aspects of disease in clinical medicine. The patient's mind and his/her social world are not of great significance from the natural scientific perspective. Medical professionals may thus easily regard their clinical task solely as the physical treatment of physical disorders. They are very likely to consider many communicative activities as unrelated to their clinical task. Inadequate doctor-patient communication can easily affect the quality of medical care and patient outcomes in a negative manner, as well as diminish the quality of the doctor's occupational experience. For this reason I conclude that medicine's natural scientific intellectual self-image is not appropriate for the task of providing medical care to individual patients. Two additional reasons support this conclusion, namely the misidentification of clinical medicine as a natural science and the inappropriateness of a scientific conception of truth for the context of doctor-patient interactions. The implications of these conclusions are that the intellectual self-image and world-view of modern medicine should change to better agree with the nature of clinical practice and to make room for the psychological and social dimensions of the patient's life within health care. The medical profession should also revise its conception of science to a theory that acknowledges that interpretive reasoning and knowledge without guaranteed certainty are legitimate elements of science. I advocate for consciousness among the medical profession of the reality of medical discourse and its effects on doctors, patients and on their interaction with one another.

AFRIKAANSE OPSOMMING: Kommunikasie tussen dokters en pasiënte in kliniese omgewings is daarvoor berug om moeilik te wees. Hierdie probleem het 'n magdom empiriese navorsing vanuit 'n verskeidenheid van akademiese velde omtrent dokter-pasiënt kommunikasie geïnspireer. Baie min aandag word egter gewy aan die rol van moderne geneeskunde se intellektuele selfbeeld as 'n natuurwetenskap in interaksies in kliniese mediese omgewings. Die doel van die huidige studie was om die invloed van die mediese professie se intellektuele selfbeeld op kommunikasie tussen dokters en pasiënte filosofies te ondersoek. Jürgen Habermas se werk oor Universele Pragmatiek (Universal Pragmatics) is gebruik om kommentaar te lewer oor dokter-pasiënt kommunikasie soos wat dit beskryf word in die empiriese navorsingsliteratuur. Michel Foucault se werk oor diskoers en mag is gebruik om mediese diskoers en die aard van mag in dokter-pasiënt verhoudings te ontleed en te beskryf. Hierdie filosofiese ontleding gee aanleiding tot die gevolgtrekking dat moderne geneeskunde se intellektuele selfbeeld 'n deurdringende en negatiewe invloed op kommunikasie tussen dokters en pasiënte gedurende kliniese konsultasies het. Die rede hiervoor is dat geneeskunde se positivistiese wêreldbeskouing lei tot 'n byna uitsluitlike fokus op die fisiese aspekte van siekte in kliniese geneeskunde. Die pasiënt se verstand en gees (mind) en sy/haar sosiale wêreld is nie van groot belang vanuit die natuurwetenskaplike perspektief nie. Persone in die mediese beroep mag hul kliniese taak dus maklik as bloot die fisiese behandeling van fisiese afwykings beskou. Dit is baie waarskynlik dat hulle vele kommunikatiewe aktiwiteite as onverwant tot hul kliniese taak beoordeel. Ontoereikende dokter-pasiënt kommunikasie kan die kwaliteit van mediese sorg en pasiënte se gesondheidsuitkomste maklik negatief beïnvloed, en ook die kwaliteit van die dokter se ervaring van sy/haar beroep verlaag. Om hierdie rede maak ek die gevolgtrekking dat geneeskunde se natuurwetenskaplike intellektuele selfbeeld nie toepaslik is vir die opdrag om mediese sorg aan individuele pasiënte te lewer nie. Twee verdere redes ondersteun hierdie gevolgtrekking, naamlik die verkeerdelike identifikasie van kliniese geneeskunde as 'n natuurwetenskap en die onvanpastheid van 'n wetenskaplike konsepsie van waarheid vir die konteks van dokter-pasiënt interaksies. Die implikasies van hierdie gevolgtrekkings is dat die intellektuele selfbeeld en wêreldbeskouing van moderne geneeskunde moet verander om beter ooreen te stem met die aard van die kliniese praktyk en om ruimte te maak vir die sielkundige en sosiale dimensies van die pasiënt se lewe in gesondheidsorg. Die mediese professie moet ook haar konsepsie van die wetenskap hersien na 'n teorie wat erken dat interpreterende redenasie en kennis sonder gewaarborgde sekerheid, geregverdigde elemente van die wetenskap is. Ek pleit vir bewustheid onder die mediese professie van die realiteit van mediese diskoers en die effek daarvan op dokters, pasiënte en op hul interaksie met mekaar.

Please refer to this item in SUNScholar by using the following persistent URL: http://hdl.handle.net/10019.1/85649
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