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Article Excerpt
Abstract: This study uses the seven nonsequential stages of the physician/patient visit as a framework to analyze the interactions between an African American woman patient and her White male physician at a primary care clinic in a New England private university. Cultural differences between the patient and the physician (e.g., gender, ethnicity, age, and economics) contribute to dilemmas of their communication. This study uses the seven stages of the physician/patient visit as a framework of analysis. The features emerged during analysis of health care visits between a White male physician and Native American women patients at a public health facility. Primary findings show that (a) the patient and physician do not share understanding of the primary purpose of the health care visit; (b) the physician "s discourse reveals organizational assumptions that the patient will seek health care options after information is given to her; (c) patient and physician lack effective communication skills; and (d) the physician's reliance on the organizational perspective conflicts with patient's goals and needs. The barriers illustrate that changes in organizational goals and health policies are needed for the improved health of all people in the United States, changes particularly critical to women of color, who remain the population most at risk due to barriers to health communication and health care.
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This study analyzes the interactions between a White male middleclass physician and an African American woman patient. The health care visit took place at a New England teaching hospital in a primary care clinic. During the last four decades, scholarship in many disciplines has shown the importance of positive interactions between physicians and their patients. Research by Street, Jr. and Wiemann (1987), Conlee, Olvera, and Vagina (1993), McMurray, Williams, Schwartz, et al. (1997), and Lammer and Duggan (2003) are among studies that support the assumption that satisfactory health care for patients and physicians leads to better health care. Researchers have also found that cultural differences negatively impact health care interactions (Helman, 1995; Kreps & Kunimoto, 1994; Parrot & Condit, 1996; Young & Kingle, 1996). That conflict because of cultural differences is inevitable but does not have to be negative. Yet, research about interactions in the health care visit seldom focus on cultural group representatives. I examined in this study, interactions between a culturally different male physician and his female patient.
Review of Previous Research
My discussion of women and health communication begins with the feminist assumption, as articulated in standpoint theory (Collins, 1986; Haraway, 1988), that the United States of America is a patriarchal society in which women are perceived not only to have different types of power and voice but that their power and voice have less significance than men, particularly White men with economic power who require validation by representatives of the patriarchy (Wood, 1993, 2000).
Parrott and Condit (1996), Stem (1996), Gabbard-Alley (1995) and others note the particular problems facing women and their health. Beck (1997) notes, "Study after study suggests the existence of a grave problem in the United States that is impacting more than half of the U.S. population---the women's health care crisis" (p. 1). If the patient is a woman of color, it adds another level of difficulty achieving satisfactory and good health care communication (Murrell, Smith, Gill, & Oxley, 1996; Spector, 1996; Witte & Morrison, 1995). The relationship between culture and health-related beliefs and behaviors is complex (Helman, 1995; Spector, 1996).
Some research on African American women and health has been done. Gates (1997) studied dietary risk factors for cardiovascular disease in African American and White women. Irwin (1997) reviewed diabetes health concerns. Hill (1997) discusses the hormone levels during dietary changes in pre-menopausal African American women that put them at a higher risk for breast cancer than White women. Hamilton-Houston (1995) noted the influences of HMOs for urban low-income women. Liu (1996) discovered that African American women of low income have poorer dietary habits than low income White women. Murrell, Smith, Gill, and Oxley (1996) focus on racism and the problems of accessing health care among women of childbearing age. Wingood (1997) studied the effects of abusive partners on condom use among African American women and their partners. Dalichinan, Kelley, Hunter, Murphy, and Tyler (1983) discuss the need for special language in the design of risk-reduction messages related to AIDS.
Previous research studies have called for (a) audience-centered messages for African American women and HIV prevention (Bond, 1997); (b) changes in surveys to be appropriate for African American women (Nelson, 1994; Pasick, 1996); (c) changes in framework to guide future research based on religion and ethnicity differences in African American families and health issues (Irwin, 1997; Kelley, 1992); and (d) attention to be given for the development of protocols and perceptions of appropriate behavior and reaction to symptoms that are often negatively influenced by racial biases and stereotypes (Jackson & Parks, 1997). These studies call attention to the differences that ethnicity and socioeconomic status bring to the interaction between physician and patient.
Few studies have focused on the physician and patient interactions involving African American women. The research previously noted reveals some of the health problems, but data do not reveal the interactions as they occur in the health care visit, which, conceivably, influence health outcomes. Such data are necessary so that the words of the physician and the patient reveal their perspectives and their conflicts.
The research question for this case study is: If one presumes that cultural differences are barriers to successful health communication, what flawed portions of the interactions exist, presenting barriers to successful health communication in this case of communication between an older urban-poor African American and her younger White male middleclass physician?
This study does not presume that the patient in this case study is representative of all urban African American women of her age or that the physician's discourse represents the perspectives of all younger white male middleclass doctors. Still, their shared experience is significant and may be illustrative. This case study can inform health communication research because this is real talk.
Theory
From interpretive studies that describe interaction, the use of analysis of discourse is a useful methodology that takes its existence from many sources: rhetoric, semiotics, discourse analysis, conversation analysis, ethnography, and grounded theory. Such methodologies are used to examine the discourse of people as they create and maintain their world. The analysis of naturalistic discourse, as it appears in organizational settings, including health care institutions, allows the worldviews or the perspectives of the participants and the organizations that they represent to emerge (Dixon & Shaver, 2000; Shaver, L. Dixon, 1997a, b; L. Shaver, & P. Shaver, 1995). These differences between the interactants known as sites of conflict represent the major agons or dilemmas in the interactions (Burke, 1966, 1969a, 1969b).
In this study,...
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