Hostname: page-component-586b7cd67f-gb8f7 Total loading time: 0 Render date: 2024-11-28T23:46:30.741Z Has data issue: false hasContentIssue false
  • English
  • Français

Communication Between Provider and Patient: Values, Biography, and Empowerment in Clinical Practice

Published online by Cambridge University Press:  09 November 2018

Phillip G. Clark
Phillip G. Clark*
Affiliation:
Program in Gerontology, The University of Rhode Island, Kingston, R1 02881, U.S.A.
Get access Rights & Permissions [Opens in a new window]

Abstract

Communication between elderly people and their health care providers is becoming more important due to the chronic nature of geriatric health problems and their impact on quality of life. At the core of the challenge of improving this dialogue are factors related to essential human values and the clash between two different cultures – one scientific and the other personal. Only by gaining an understanding of this clinical decisionmaking interaction can new approaches to bridge the communication gap be developed. The purpose of this paper is fourfold: (1) to summarise the fundamentally different bases for communication between health care provider and patient, (2) to discuss the shortcomings of various methods (such as advance directives) to embody patients’ wishes about their care, (3) to review new models of geriatric care that have implications for this communication process, and (4) to develop a framework – based on biographical methods and the concept of empowerment – that suggests some potential solutions to these communication problems. Such methods reflect new approaches to developing life stories and themes suggestive of ways to retain the personal life voice of the individual in the development of a clinical partnership with the health care provider.

Keywords

Communicationvaluesbiographyempowermentclinical practiceadvance directivesquality of lifeself-careethicsend-of-life decision making
Type
Research Article
Information
Ageing & Society , Volume 16 , Issue 6: Special Issue: Ageing, Biography and Practice , November 1996 , pp. 747 - 774
Copyright
Copyright © Cambridge University Press 1996

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Andre, J. 1992. Learning to see: moral growth during medical training. Journal of Medical Ethics, 18, 148–152.Google Scholar
Ansello, E. F. 1992. Seeking common ground between aging and developmental disabilities. Generations, 16, 9–15.Google Scholar
Ansello, E. F. and Eustis, N. N. 1992. A common stake? Investigating the emerging ‘intersection’ of aging and disabilities. Generations, 16, 5–8.Google Scholar
Ansello, E. F. and Rose, T. 1989. Aging and Lifelong Disabilities: partnership for the Twenty-first Century. Elvirita Lewis Foundation, Palm Springs, CA.Google Scholar
Aumann, G. M.-E. and Cole, T. R. 1991. In whose voice? Composing a lifesong collaboratively. The Journal of Clinical Ethics, 2, 45–49.Google Scholar
Boetzkes, E. 1993. Autonomy and advance directives. Canadian Journal on Aging, 12,441–452.Google Scholar
Burnside, I. 1996. Life review and reminiscence in nursing practice. In Birren, J., Kenyon, G., Ruth, J.-E. Schroots, J. J. F. and Svensson, T. (eds), Aging and Biography: Explorations in Adult Development. Springer Publishing Co., New York, 248–264.Google Scholar
Carse, A. L. 1993. Justice within intimate spheres. The Journal of Clinical Ethics, 4, 68–71.Google Scholar
Clark, P. G. 1987. Individual autonomy, cooperative empowerment, and planning for long-term care decision-making. Journal of Aging Studies, 1, 65–76.Google Scholar
Clark, P. G. 1988. Autonomy, personal empowerment, and quality of life in long-term care. Journal of Applied Gerontology, 7, 279–297.CrossRefGoogle Scholar
Clark, P. G. 1989. The philosophical foundation of empowerment: implications for geriatric health care programs and practice. Journal of Aging and Health, 1, 267–285.Google Scholar
Cohler, B. J. and Cole, T. R. 1996. Studying older lives: reciprocal acts of telling and listening. In Birren, J., Kenyon, G., Ruth, J.-E., Schroots, J. J. F. and Svensson, T. (eds), Aging and Biography: Explorations in Adult Development. Springer Publishing Co., New York, 61–76.Google Scholar
Davidson, W. A. S. 1991. Metaphors of health and aging: geriatrics as metaphor. In Kenyon, G. M., Birren, J. E. and Schroots, J. J. F. (eds), Metaphors of Aging in Science and the Humanities. Springer Publishing Co., New York, 173–184.Google Scholar
Dean, K., Hickey, T. and Holstein, B. E. (eds). 1986. Self-care and Health in Old Age. Croom Helm, London.Google Scholar
DeFriese, G. H. and Konrad, T. R. 1993. The self-care movement and the gerontological health care professional. Generations, 17, 37–40.Google Scholar
Delbanco, T. L. 1992. Enriching the doctor-patient relationship by inviting the patient's perspective. Annals of Internal Medicine, 116, 414–418.Google Scholar
Doukas, D. J., Lipson, S. and McCullough, L. B. 1989. Values history. In Reichel, W. (ed), Clinical Aspects of Aging (3rd Edition). Williams and Wilkins, Baltimore, 615–616.Google Scholar
Doukas, D. J. and McCullough, L. B. 1991. The values history: the evaluation of the patient's values and advance directives. Journal of Family Practice, 32, 145–153.Google Scholar
Doukas, D. J. and Gorenflo, D. W. 1993. Analyzing the values history: an evaluation of patient medical values and advance directives. The Journal of Clinical Ethics, 4, 41–45.Google Scholar
Doukas, D. J., Gorenflo, D. W. and Venkateswaran, R. 1993. Understanding patients’ values [letter]. The Journal of Clinical Ethics, 4, 199–200.Google Scholar
Elliott, C. 1993. Meaning what you say. The Journal of Clinical Ethics, 4, 61–62.Google Scholar
Emanuel, L. L. 1993. Advance directives: What have we learned so far? The Journal of Clinical Ethics, 4, 8–16.Google Scholar
Emanuel, L. L. and Emanuel, E. J. 1989. The medical directive: a new comprehensive advance care document. Journal of the American Medical Association, 261, 3288–3293.Google Scholar
Emanuel, L. L., Barry, M. J., Stoeckle, J. D., Ettelson, L. M. and Emanuel, E. J. 1991. Advance directives for medical care - a case for greater use. New England Journal of Medicine 324, 889–895.Google Scholar
Fine, R. L. 1991. Personal choices: communication between physicians and patients when confronting critical illness. The Journal of Clinical Ethics, 2, 57–62.Google Scholar
Fisher, R. H. and Meslin, E. M. 1990. Should living wills be legalized? Canadian Medical Association Journal, 142, 23–26.Google Scholar
Forrow, L., Gogel, E. and Thomas, E. 1991. [Letter to the editor]. New England Journal of Medicine, 325, 1255.Google Scholar
Gearing, B. and Coleman, P. G. 1996. Biographical assessment in community care. In Birren, J., Kenyon, G., Ruth, J.-E. Schroots, J. J. F. and Svensson, T. (eds), Aging and Biography: Explorations in Adult Development. Springer Publishing Co., New York, 265–282.Google Scholar
Gergen, K. J. 1996. Beyond life narratives in the therapeutic encounter. In Birren, J., Kenyon, G., Ruth, J.-E., Schroots, J. J. F. and Svensson, T. (eds), Aging and Biography: Explorations in Adult Development. Springer Publishing Co., New York, 205–223.Google Scholar
Gubrium, J. and Buckholdt, D. 1977. >Toward Maturity. Jossey-Bass, San Francisco.Google Scholar
Harrison, C. 1993. Personhood, dementia, and the integrity of a life. Canadian Journal on Aging, 12, 428–440.Google Scholar
High, D. M. 1988. All in the family: extended autonomy and expectations in surrogate health care decisionmaking. The Gerontologist, 28 (3, Suppl.), 46–51.Google Scholar
High, D. M. 1990. Who will make health care decisions for me when I can’t? Journal of Aging and Health, 2, 291–309.Google Scholar
High, D. M. 1991. A new myth about families of older people? The Gerontologist, 31, 611–618.Google Scholar
Kaufman, S. R. 1986. The Ageless Self: Sources of Meaning in Late Life. The University of Wisconsin Press, Madison, WI.Google Scholar
Kenyon, G. M. 1996. The meaning/value of personal storytelling. In Birren, J., Kenyon, G., Ruth, J.-E., Schroots, J. J. F. and Svensson, T. (eds), Aging and Biography: Explorations in Adult Development. Springer Publishing Co., New York, 21–38.Google Scholar
Kohn, M. and Menon, G. 1988. Life prolongation: views of elderly outpatients and health care professionals. Journal of the American Geriatrics Society, 36, 840–844.Google Scholar
Lorig, K. 1993. Self-management of chronic illness: a model for the future. Generations, 17, 11–14.Google Scholar
Matthews, D. A., Suchman, A. L. and Branch, W. T. 1993. Making “connexions”: enhancing the therapeutic potential of patient-clinician relationships.Annals of Internal Medicine, 118, 973–977.Google Scholar
McCullough, L. B. 1988. An ethical model for improving the patient-physician relationship. Inquiry, 25, 454–468.Google Scholar
Miller, R.J. 1991. [Letter to the editor]. New England Journal of Medicine, 325, 1254–1255.Google Scholar
Miller, D. K., Coe, R. M. and Hyers, T. M. 1992. Achieving consensus on withdrawing or withholding care for critically ill patients. Journal of General Internal Medicine, 7, 475–480.Google Scholar
Mishler, E. G. 1984. The Discourse of Medicine: Dialectics of Medical Interviews. Ablex Publishing Corporation, Norwood, NJ.Google Scholar
Mold, J. W. 1995. An alternative conceptualization of health and health care: Its implications for geriatrics and gerontology. Educational Gerontology, 21, 85–101.Google Scholar
Mold, J. W., Blake, G. H. and Becker, L. A. 1991. Goal-oriented medical care. Family Medicine, 23, 46–51.Google Scholar
Mount, B. and Zwernik, K. 1989. It’s Never Too Early. Publication No. 421-88-109. Metropolitan Council, St. Paul, MN.Google Scholar
Orentlicher, D. 1992. The illusion of patient choice in end-of-life decisions. Journal of the American Medical Association, 267, 2101–2104.Google Scholar
Pearlman, R. A., Cain, K. C. Patrick, D. L., Appelbaum-Maizel, M., Starks, H. E., Jecker, N. S. and Uhlmann, R. F. 1993. Insights pertaining to patient assessments of states worse than death. The Journal of Clinical Ethics, 4, 33–41.Google Scholar
Poirier, S. and Brauner, D. J. 1988. Ethics and the daily language of medical discourse. Hastings Center Report, 18, 5–9.Google Scholar
Reiser, S. J. 1993. The era of the patient: using the experience of illness in shaping the missions of health care. Journal of the American Medical Association, 269, 1012–1017.Google Scholar
Risse, G. B. 1982. Once on top, now on tap: American physicians view their relationships with patients, 1920-1970. In Agich, G. J. (ed), Responsibility in Health Care. D. Reidel Publishing Company, Dordrecht, Holland, 23–49.Google Scholar
Roter, D. L. and Hall, J. A. 1992. Doctors talking with patients I patients talking with doctors. Auburn House, Westport, CT.Google Scholar
Ruth, J.-E. and Kenyon, G. M. 1996. Biography in adult development and aging. In Birren, J., Kenyon, G., Ruth, J.-E., Schroots, J. J. F. and Svensson, T. (eds), Aging and Biography: Explorations in Adult Development. Springer Publishing Co., New York, 1–20.Google Scholar
Sachs, G. A. 1993. Improving advance directives: more dialogue, not more laws. The Journal of Clinical Ethics, 4, 171–173.Google Scholar
Schneiderman, L.J., Kaplan, R. M., Pearlman, R. A. and Teetzel, H. 1993. Do physicians' own preferences for life-sustaining treatment influence their perceptions of patients’ preferences? The Journal of Clinical Ethics, 4, 28–33.Google Scholar
Schön, D. A. 1987. Educating the Reflective Practitioner. Jossey-Bass, San Francisco.Google Scholar
Schutz, A. 1962. Collected Papers, Vol. 1: The Problem of Social Reality. Martinus Nijhoff, The Hague.Google Scholar
Schutz, A. 1970. On Phenomenology and Social Relations (Wagner, H. K. ed). University of Chicago Press, Chicago.Google Scholar
Scissors, K. 1991. [Letter to the editor]. New England Journal of Medicine, 325, 1255.Google Scholar
Secundy, M. G. 1993. Balancing communication skills and clinical assessment. The Journal of Clinical Ethics, 4, 185–186.Google Scholar
Starr, J. M. 1983. Toward a social phenomenology of aging: studying the self process in biographical work. International Journal of Aging and Human Development, 16, 255–270.Google Scholar
Tomlinson, T. and Brody, H. 1988. Ethics and communication in do-not-resuscitate orders. New England Journal of Medicine, 318, 43–46.Google Scholar
Veatch, R. M. 1982. Medical authority and professional medical authority: the nature of authority in medicine for decisions by lay persons and professionals. In Agich, G. J. (ed), Responsibility in Health Care. D. Reidel Publishing Company, Dordrecht, Holland, 127–137.Google Scholar
Wasson, J. and Jette, A. M. 1993. Partnerships between physicians and older adults. Generations, 17. 41–44.Google Scholar