A multimodal social semiotic approach to patient-centered communication

Abstract

This chapter contributes to understanding the complexities of doctor-patient communication in a South African medical setting. In particular, it explores how medical students signal credibility as (future) medical experts while counseling patients on potentially life-threatening matters. Using multimodal social semiotics combined with a critical realist perspective, we examine medical students’ production of personalized health promotion artefacts and written critical reflections. A social semiotic analysis of students’ texts enables a thick description of meaning-making choices, while a critical realist approach makes visible the deep causal factors strengthening or inhibiting a patient-centered approach in clinical settings. Medical students’ construction of a trustworthy ‘voice’ is constantly shaped in communication with peers (‘insiders’), with patients, and with patients’ families (‘outsiders’). Health education of patients requires not only epistemic but also relational recontextualization, as social roles and power differentials need to be negotiated with new ‘audiences’. Both authorial stance and patient engagement are thus discursively grounded. This chapter demonstrates the tension between students’ understanding of patient autonomy and professional responsibility towards patients. It highlights the complexity of learning to handle asymmetrical power while fostering sustainable, transformational citizenship.