Clinical Paternalistic Model and Problematic Situation: A Critical Evaluation of Clinical Counseling

Ahmad Kalateh Sadati, Kamran Bagheri Lankarani, Halimeh Enayat, Akbar Rasekhi Kazerooni, Sara Ebrahimzadeh

Abstract


Background: Many of health system services are done in clinical counseling. A patient’s expectation of clinical consultation and physician office visits is to obtain diagnostic-remedial results, while such an expectation can be fulfilled only through an active relationship between the doctor and the patient. The aim of this study is to evaluate the quality of doctor- patient interaction in an educational clinic in southern Iran. Methods: This is a conversation analysis based on critical approach. So, 33 clinical consultations were analyzed critically. Results: Results showed that paternalistic model is the overall pattern in consultations. This leads to limitation of the patients’ opportunity to participate in their diagnosis and treatment. Powers’ asymmetrical relations lead to conditions in which physicians determine the clinical counseling process. Also, physicians determine the subject of consultation in the counseling period. In this situation, the patients’ concerns were ignored. This ignorance leads to the patients’ suppression in problematic situations. The main point is that the clinical counseling occurs in one general contract that is unwritten but has been known for the two sides of interaction. Conclusion: Clinical counseling can be an active consultation when it included the symmetrical distribution of power and the patient has an active participation in the consultation. Therefore, the new patient-centered approaches can be an appropriate model for access to a type of consultation based on symmetrical power distribution between physician and patient.


Keywords


Doctor- patient interaction; Paternalism; Problematic situation; Suppression

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References


Cordella M. The Dynamic Consultation A discourse

analytical study of doctor–patient relation. Amsterdam:

John Benjamins Publishing Company; 2004.

Parsons T. The Social System. England: Routledge;

Turner, BH. Introduction. In The Social System.

England: Routledge; 1991.

Armstrong, D. Bodies of Knowledge/Knowledge of

Bodies. In Jones, C. and Porter, R. (eds) Reassessing

Foucault. Power, medicine and the body, London:

Routledge;1994:17-27.

Driver, F. Bodies in Space: Foucault’s Account of

Disciplinary Power. Bodies. In Jones, C. and Porter,

R. (eds) Reassessing Foucault. Power, medicine and the

body. London: Routledge; 1994: 113- 131.

Foucault M. The Birth of the Clinic. An Archeology

of Medical Perception. Sheridan AM (translate). UK:

Tavistock Publications Limited; 1973.

McGowen, R. Power and Humanity, or Foucault Among

the Historians. In Jones, C. and Porter, R. Reassessing

Foucault. Power, medicine and the body. London:

Routledg; 1994: 91-112.

Habermas, J. Theory of Communicative Action, Vol. 2.

Lifeworld and System. Cambridge: Polity Press; 1978.

Scambler, G. Habermas a nd t he Power of M edical

Experties. In Scambler, G. (eds) Medical Sociology.

Major Themes in Health and Social Welfare. USA:

Routledge; 2005: 138-162.

Scambler, G. and Britten, N. System, lifeworld and

doctor–patient interaction Issues of trust in a changing

world. In Scambler, G. (eds) Habermas, critical theory

and Health. London: Routledge; 2001: 45-67.

Powers, P. The Philosophical Foundations of Foucaultian

Discourse Analysis. Critical Approaches to Discourse

Analysis across Disciplines 2007; 1(2): 18-34.

Barry ChA, Stevenson FA, Britten N, Bradley CP.

Giving voice to the lifeworld. More humane, more

effective medical care? A qualitative study of doctor–

patient relation in general practice. Soc Sci Med 2001;

: 487–505.

Fairclough N. Discourse and Social Changes. USA:

Polity Press; 1992.

Králová P. Power Relations in doctor- patient relation.

Kamenice: Masaryk University; 2012 [cited: 2013 Aug

. available from: http://is.muni.cz/th/361459/ff_b/

Thesis.pdf.

Islam G, Zyphur M. Ways of interacting: The

standardization of relation in medical training. Hum

Relat 2007; 6(5): 769-92.

Mishler, GE. The Discourse of Medicine: dialectics

of medical interviews. Norwood, New Jersey: Ablex

Publishing Company; 1984.

Heritage and myard

American Sociological Association. Code of Ethics

and Policies and Procedures of the ASA Committee

on Professional Ethics. 1997 [updated 2008 May 10;

cited: 2014 Jan 1]. Available from: http://www.asanet.

org/images/asa/docs/pdf/Ethics%20Code.pdf

Wells K. Narrative Inquiry. USA: Oxford University

Press; 2011.

Gee, JP. An Introduction to Discourse Analysis, Theory

and Method. Third Edition. New York: Routledge; 2010.

Emanuel JE, Emanuel LL. Four Model of the Physicianpatient

relationship. Am J Med Sci 1992; 267(16): 5-13.

Merriam- webster online dictionary. Marginalize.

[cited: 2014 22 May] Available from: http://www.

merriam-webster.com/dictionary/marginalize

McKinney, J. PTSD Patients Marginalized by the

Current Healthcare System. 2012. Available from:

http://www.thomhartmann.com/users/johnmckinney/

blog/2012/11/ptsd-patients-marginalized-currenthealthcare-

system-11122012.

Atkinson, P. M edical Talk a nd M edical Work.

London: S age p ub; 1995.

Bensing, J. Bridging the gap. The separate worlds

of Evidence-based medicine and p atient-centered

medicine. Patient Educ Couns 2000; 39: 17-25.

Forman, H. Nursing Leadership For Patient-Centered

Care. Authenticity Presence Intuition Expertise. New

York: Springer Publishing Company; 2011.

Mengel, MB. The Systemic Patient-Centered Method.

Introduction to Clinical Skills : A Patient-centered

Textbook. Mengel, MB, Scott, AF (eds). Plenum Press;

Watson, J., Frampton, SB. Human Interactions and

Relationship – centered Caring. Putting Patients

First. Best Practices in Patient-Centered Care. Second

Edition. Editors Frampton, SB. and Charmel PA; 2009.

Pendleton D, Schofield Th, Tate P, Havelock P. The New

Consultation Developing doctor–patient communication.

New York: Oxford University press; 2003.

Sadati AK, Iman MT, Lankarani KB. Medical

Paraclinical Standards, Political Economy of Clinic,

and Patients’ Clinical Dependency; A Critical

Conversation Analysis of Clinical Counseling in South

of Iran. IJCBNM 2014; 2(3): 157-68.


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