Older patient-physician communication: an examination of the tensions of the patient-centred model within a biotechnological context.

Abstract

Drawing on existing theoretical work, as well as field research, this dissertation examines the impact of medical imaging technologies on communication between physicians and older patients when diagnostics often privilege disembodied data over the patient voice. Current diagnostic trends are contextualized within the history of medicine, from Ancient Greece to the present, including the development of imaging. Since the 1970s, advanced medical imaging technologies (e.g., ultrasound, computed tomography, magnetic resonance imaging) have become the diagnostic norm in Western medicine. The rapidity of this shift, which renders the human body as flattened data, can outstrip considerations of the implications of applying such technologies to living patients. Focusing on older patients, who may be less technologically savvy than younger patients or medical professionals, the field research begins with semi-structured interviews of patients over age sixty-five, exploring their encounters with medical imaging equipment and professionals. This data is interrogated qualitatively using Foucauldian discourse analysis drawing on Andrea Doucet’s model of slow scholarship, and informed by Arthur Frank’s notion of letting stories breathe; themes were allowed to surface from the patients’ narratives, rather than imposed by the researcher. Information emerging from the data considers patients’ emotions, unexpected physical sensations, communicative strategies and rationalizations, as well as Foucauldian allusions to power. Observational research was also conducted during encounters between physicians and simulated patients in the presence of medical images; these encounters were followed by reflective exit interviews. Research indicates that although physicians are increasingly trained in patient-centred communication, it is not always optimally practised. Physicians are sometimes more comfortable with the medical discourse of disease than with the emotional, metaphoric language of the patient’s illness experience. Since the development of modern Western medicine in Europe of the late 1700s, physicians have been trained to seek pathology, with the increasing aid of medical technologies, rather than listening to their patients. For older patients, who may experience multiple co-morbidities, the lack of communication around advanced medical technologies can increase their sense of vulnerability and anxiety. The dissertation concludes with recommendations for both patients and practitioners to improve communication in the medical context.