The clinical encounter as local moral world: Shifts of assumptions and transformation in relational context

Abstract

In this study we consider the process of the clinical encounter, and present exemplars of how assumptions of both clinicians and their patients can shift or transform in the course of a diagnostic interview. We examine the process as it is recalled, and further elaborated, in post-diagnostic interviews as part of a collaborative inquiry during reflections with clinicians and patients in the northeastern United States. Rather than treating assumptions by patients and providers as a fixed attribute of an individual, we treat them as occurring between people within a particular social context, the diagnostic interview. We explore the diagnostic interview as a landscape in which assumptions occur (and can shift), navigate the features of this landscape, and suggest that our examination can best be achieved by the systematic comparison of views of the multiple actors in an experience-near manner. We describe what might be gained by this shift in assumptions and how it can make visible what is at stake for clinician and patient in their local moral worlds – for patients, acknowledgement of social suffering, for clinicians how assumptions are a barrier to engagement with minority patients. It is crucial for clinicians to develop this capacity for reflection when navigating the interactions with patients from different cultures, to recognize and transform assumptions, to notice ‘surprises’, and to elicit what really matters to patients in their care.

Influencing everyday activities in a nursing home setting: A call for ethical and responsive engagement

“…It is ethical in the sense that acknowledges the relevance of activities in this phase of life and context. This engagement, as revealed in the exemplars, could be enacted through small‐scale events within everyday activities, adding the acting dimension to care The understanding of influence illuminated in this study differs from conceptualizations of autonomy and decision‐making grounded in individualism, proposing a relational and acting understanding instead (Abma & Baur, 2015; Baur et al., 2013; Cardol et al., 2002; Ceci, Ttir, et al., 2013; Katz & Alegria, 2009; Nolan et al., 2004). …”

“…The analysis comprised three analytical levels: field notes corpus (Emerson et al., 2001), vignettes, and exemplars. For a preliminary analysis, segments of the field notes that stood out as striking events (Katz & Alegria, 2009) were highlighted and selected right after a day of fieldwork (first analytic text). As a result, new questions were written down to guide the forthcoming observations at the NH.…”

Integrative qualitative communication analysis of consultation and patient and practitioner perspectives: Towards a theory of authentic caring in clinical relationships

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Illness experiences of persons with chronic obstructive pulmonary disease: self-perceived efficacy of home-based pulmonary rehabilitation

“…3,19,20 . Does the health professionals' dominant discourse about COPD de-legitimize the opinion of those suffering its aftermath 21 ?…”