Health Encounters with Minority Patients

Authors

  • Ragnhild Ihle
  • Tobba Therkildsen Sudmann

DOI:

https://doi.org/10.7577/fleks.1230

Abstract

During recent decades there has been an increasing claim for patient participation and shared decision-making in health services across the Western world. Focus on participation recasts the relationship between healthcare providers and their patients. Professionals are compelled to acquaint themselves with new worldviews, new ways of understanding illness and disease, and to communicate with patients with language, religion and cultural backgrounds increasingly different from their own.

Contested concepts such as communication, tolerance, participation and shared decision-making emerge, as do claims about non-participation, oppressive practice and muting of patients. In this article we look into how the paternalistic tenets of intercultural communication, tolerance and the culture of medicine intersect in such ways that empowerment and shared decision-making in health can be constrained. Modern day health concerns such as lifelong disabilities or chronic illness have multiple faces, and there is no one agreed-upon approach to assessment, treatment or non-treatment. Patients and providers have to engage in communication to detect enablers and constraints, bodily and socially. If communication is envisioned as a one-way delivery of knowledge or prescriptions, or a difference in culture is magnified to a degree that other characteristics fade away, the patient risks oppression, muting, and poor healthcare.

We argue in favour of appropriating a critical perspective on interaction in healthcare and intercultural communication, and in favour for interpreting face-to-face interaction as situated social practice. A situated social practice compels those present to communicate to create an agreed-upon situational definition, and to enter into a recuperative dialogue where patients too may exercise agency and present themselves as empowered.





References

Adebe, D. S. (2010). Public Health Challenges of Immigrants in Norway: A Research Review. NAKMI Report 2/2010. Oslo.

Ardener, S. (1978). Defining Females. London: Croom Helm.

Arnstein, S. R. (1969). A Ladder of Citizen Participation. Journal of the American Institute of Planners,35(4), 216-224. http://dx.doi.org/10.1080/01944366908977225

Askheim, O. P. (2012). Empowerment i helse- og sosialfaglig arbeid: floskel, styringsverktøy, eller frigjøringsstrategi? Oslo: Gyldendal akademisk.

Bastalich, W. (2009). Reading Foucault: Genealogy and Social Science Research Methodology and Ethics. Sociological Research Online, 14(2), 3. http://dx.doi.org/10.5153/sro.1905

Bauman, Z. (1999). Culture as Praxis. London: Sage.

Beresford, P. (2002). User Involvement in Research and Evaluation: Liberation or Regulation? Social Policy and Society, 1(2), 95-106. http://dx.doi.org/10.1017/S1474746402000222

Brown, W. (2004). Tolerance as/in Civilizational Discourse. Redescriptions: Political Thought, Conceptual History and Feminist Theory, 8(1), 52-84.

Brown, W. (2009). Regulating Aversion: Tolerance in the Age of Identity and Empire. Princeton, N.J.: Princeton University Press.

Burr, V. (2003). Social Constructionism. London: Routledge.

Campbell, P. (2005). From Little Acorns–The Mental Health Service User Movement. In A. Bell & P. Lindley (Eds.), Beyond the Water Towers. The Unfinished Revolution in Mental Health Services 1985-2005 (pp. 73-82). London: Sainsbury Centre for Mental Health.

Charles, C., Gafni, A., & Whelan, T. (1997). Shared Decision-Making in the Medical Encounter: What Does it Mean? (Or it Takes at Least Two to Tango). Social Science & Medicine, 44(5), 681-692.
http://dx.doi.org/10.1016/S0277-9536(96)00221-3

Collier, M. J., & Thomas, M. (1988). Cultural Identity: An Interpretive Perspective. In Y. K. Young & W. B. Gudykunst (Eds.), Theories in Intercultural Communication. London: Sage.

Cornwall, A. (2008). Unpacking 'Participation': Models, Meanings and Practices. Community Development Journal, 43(3), 269-283.
http://dx.doi.org/10.1093/cdj/bsn010

Cornwall, A., & Gaventa, J. (2000). From Users and Choosers to Makers and Shapers. Repositioning Participation in Social Policy. IDS Bulletine, 31(4), 50-62.
http://dx.doi.org/10.1111/j.1759-5436.2000.mp31004006.x

Dahl, Ø. (2013). Møter mellom mennesker: innføring i interkulturell kommunikasjon (2. utg. ed.). Oslo: Gyldendal Akademisk.

Deegan, P., & Drake, R. (2006). Shared Decision Making and Medication Management in the Recovery Process. Psychiatric Services, 57(11), 1636-1639. http://dx.doi.org/10.1176/appi.ps.57.11.1636

DeTurk, S. (2010). ‘Quit Whining and Tell Me About Your Experiences!’ (In)Tolerance, Pragmatism, and Muting in Intergroupp Dialogue. In T. K. Nakayama & R. T. Halualani (Eds.), The Handbook of Critical Intercultural Communication (pp. 565-584). Oxford, UK: Wiley-Blackwell.

Edwards, M., Davies, M., & Edwards, A. (2009). What Are the External Influences on Information Exchange and Shared Decision-Making in Healthcare Consultations: A Meta-Synthesis of the Literature. Patient Education and Counseling, 75(1), 37-52. http://dx.doi.org/10.1016/j.pec.2008.09.025

Foucault, M. (2002). The Order of Things. An Archeology of Human Sciences. London: Routledge.

Freire, P. (1995). Pedagogy of Hope. Reliving Pedagogy of the Oppressed. New York: Continuum.

Gadamer, H. G. (1996). The Enigmao of Health: The Art of Healing in a Scientific Age. Stanford California: Stanford University Press.

Giddens, A. (1984). The Constitution of Society: Outline of the Theory of Structuration. Cambridge: Polity Press.

Goffman, E. (1972). Encounters. Two Studies in the Sociology of Interaction. Harmondsworth: Penguin.

Goffman, E. (1983). The Interaction Order. American Sociological Review, 48(February), 1-17. http://dx.doi.org/10.2307/2095141
http://dx.doi.org/10.1086/227833

Goth, U., Berg, J., & Akman, H. (2010). The Intercultural Challenges of General Practitioners in Norway with Migrant Patients. International Journal of Migration, Health and Social Care, 6(1), 26-33. doi: http://www.emeraldinsight.com/doi/abs/10.5042/ijmhsc.2010.0447

Gudykunst, W. B., & Kim, Y. Y. (1984). Communicating with Strangers: An Approach to Intercultural Communication. New York: Random House.

Gullestad, M. (2002). Det norske sett med nye øyne: kritisk analyse av norsk innvandringsdebatt. Oslo: Universitetsforlaget.

Hall, E. T. (1973). The Silent Language. Anchor.

Handal, G., & Lauvås, P. (2014). Veiledning og praktisk yrkesteori (3. ed.). Oslo: Cappelen Damm akademisk.

Heritage, J. (2005). Conversation Analysis and Institutional Talk. In K. L. Fitch & R. E. Sanders (Eds.), Handbook of Language and Social Interaction (pp. 103-147). Mahwah, N.J.: Lawrence Eribaum Associates.

Hofstede, G. (1984). Culture's Consequences: International Differences in Work-Related Values (Vol. 5) London: Sage.

Holliday, A. (2011). Intercultural Communication and Ideology. London: Sage.

Jandt, F. E., & Tanno, D. V. (2001). Decoding Domination, Encoding Self-Determination: Intercultural Communication Research Processes. Howard Journal of Communication, 12(3), 119-135. http://dx.doi.org/10.1080/106461701753210411

Jensen, I. (2003). The Practice of Intercultural Communication-Reflections for Professionals in Cultural Meetings. url: http://www.immi.se/intercultural/abstracts/jensen-abs.htm

Jensen, I. (2011). If Culture is Practise...? A Practise Theoretical Perspective on Intercultural Communication and Mediation. In J. Finch, Nynäs, P. (Ed.), Transforming Otherness. New Jersey: Transaction Publishers.

Jensen, I., & Halkier, B. (2011). Rethinking Intercultural Network Communication as a Resource in Public Intercultural Health Communication. Journal of Intercultural Communication (27). Jensen, I., & Halkier, B. (2011). Rethinking Intercultural Network Communication as a Resource in Public Intercultural Health Communication. Journal of Intercultural Communication, (25 March). http://www.immi.se/intercultural/nr25/jensen-halkier.htm

Kramarae, C. (1981). Women and Men Speaking: Frameworks for Analysis. Rowley, Ma.:Newbury House.

Ledwith, M., & Springett, J. (2010). Participatory Practice: Community-Based Action for Transformative Change. Bristol: Policy Press.

Lupton, D. (2012). Medicine as Culture: Illness, Disease and the Body. Los Angeles: Sage.
http://dx.doi.org/10.4135/9781446254530

Malterud, K., Candib, L., & Code, L. (2004). Responsible and Responsive Knowing in Medical Diagnosis: The Medical Gaze Revisited. NORA-Nordic Journal of Feminist and Gender Research, 12(1), 8-19.
http://dx.doi.org/10.1080/08038740410005712

Maynard, D. W. (1989). On the Ethnography of Discourse in Institutional Settings. Perspectives on Social Problems, 1, 127-146. doi: www.ssc.wisc.edu/soc/faculty/pages/docs/maynard/PDF files/

Mishler, E. G. (1984). The Discourse of Medicine: Dialectics of Medical Interviews (Vol. 3). Greenwood Publishing Group.

Orbe, M. P. (1998). From the Standpoint(s) of Traditionally Muted Groups: Explicating a Co‐Cultural Communication Theoretical Model. Communication Theory, 8(1), 1-26. http://dx.doi.org/10.1111/j.1468-2885.1998.tb00209.x

Otten, M., & Geppert, J. (2009). Mapping the Landscape of Qualitative Research on Intercultural Communication. A Hitchhiker's Guide to the Methodological Galaxy. Forum qualitative sozialforschung/Forum: qualitative social research, 10(January). http://www.qualitative-research.net/index.php/fqs/article/view/1252

Parsons, T. (1975). The Sick Role and the Role of the Physician Reconsidered. The Milbank Memorial Fund Quarterly. Health and Society, 53(3), 257-278. http://dx.doi.org/10.2307/3349493

Porter, R. E., & Samovar, L. A. (1994). An Introduction to Intercultural Communication. In R. E. Porter & L. A. Samovar (Eds.), Intercultural Communication: A Reader (pp. 4-26). Belmont CA: Wadsworth

Rathje, S. (2007). Intercultural Competence: The Status and Future of a Controversial Concept. Language and Intercultural Communication, 7(4), 254-266.
http://dx.doi.org/10.2167/laic285.0

Robinson, J., Witenberg, R., & Sanson, A. (2001). The Socialization of Tolerance. In M. Augoustinos & K. Reynolds (Eds.), Understanding Prejudice, Racism, and Social Conflict (pp. 73-89). London: Sage Publications Ltd.
http://dx.doi.org/10.4135/9781446218877.n5

Rutter, D., Manley, C., Weaver, T., Crawford, M. J., & Fulop, N. (2004). Patients or Partners? Case Studies of User Involvement in the Planning and Delivery of Adult Mental Health Services in London. Social Science & Medicine, 58(10), 1973-1984. http://dx.doi.org/10.1016/S0277-9536(03)00401-5

Spilker, R. S., Indseth, T., & Aambø, A. (2009). Tilstandsrapport: Minoritetshelsefeltet i Norge Mighealthnet State of the Art Report. Oslo: Nasjonal kompetanseenhet for minoritetshelse.

Sudmann, T. T. (2009). (En)gendering Body Politics. Physiotherapy as a Window on Health and Illness. (PhD Medical Sociology), University of Bergen, Bergen. Retrieved from http://hdl.handle.net/1956/3143

Swidler, A. (2013). Talk of Love: How Culture Matters. University of Chicago Press.

Tait, L., & Lester, H. (2005). Encouraging User Involvement in Mental Health Services. Advances in Psychiatric Treatment, 11(3), 168-175.
http://dx.doi.org/10.1192/apt.11.3.168

Tambuyzer, E., Pieters, G., & Van Audenhove, C. (2014). Patient Involvement in Mental Healthcare: One Size Does Not Fit All. Health Expectations, 17(1), 138-150.
http://dx.doi.org/10.1111/j.1369-7625.2011.00743.x

Thesen, J. (2001). Being a Psychiatric Patient in the Community-Reclassified as the Stigmatized ‘Other’. Scandinavian Journal of Public Health, 29(4), 248-255. http://dx.doi.org/10.1177/14034948010290040901

Thesen, J. (2005). From Oppression Towards Empowerment in Clinical Practice—Offering Doctors a Model for Reflection. Scandinavian Journal of Public Health, 33(66 suppl), 47-52.
http://dx.doi.org/10.1080/14034950510033372

Ting-Toomey, S. (1988). A Face Negotiation Theory. Theory and Intercultural Communication, 47-92.

Ulrey, K. L., & Amason, P. (2001). Intercultural Communication between Patients and Healthcare Providers: An Exploration of Intercultural Communication Effectiveness, Cultural Sensitivity, Stress, and Anxiety. Journal of Health Communication, 13(4), 449-463.
http://dx.doi.org/10.1207/S15327027HC1304_06

Valero-Garcés, C. (2002). Interaction and Conversational Constrictions in the Relationships Between Suppliers of Services and Immigrant Users. Pragmatics, 12(4), 469-495.

Ytrehus, L. A. (2001). Forestillinger om ‘den andre’. Kristiansand: Høyskoleforlaget.

Downloads

Published

2014-12-15

How to Cite

Ihle, R., & Therkildsen Sudmann, T. (2014). Health Encounters with Minority Patients. FLEKS - Scandinavian Journal of Intercultural Theory and Practice, 1(2). https://doi.org/10.7577/fleks.1230

Issue

Section

Research articles

Cited by