Different Manifestations of Power Models of Doctor-Patient Interactions in Mosul

Contents

Abstract

Introduction

Statement of the problem

Aim of the study

Hypothesis

Power

Types of Power
French and Raven's Typology (1959)
Brody's Typology (1992)
Language and Power

Models of Doctor-Patient Interactions
a. Paternalism
b. Consumerism
c. Mutuality
d. Default

Methodology

Data collection method

Population

Sampling

Sample Size

Method of Analysis

Findings and Discussion
Extract 1
Extract 2
Extract 3

Conclusions

References

Appendices

Abstract

This study aims to investigate the notion of power in Mosuli Arabic doctor-patient encounters by establishing the kind of model of interaction adopted in doctor-patient interactions. The theoretical framework adopted in the study is Roter and Hall's (2006) typology of models. The naturalistic observation method is the method used to collect data from 10 doctors and 38 patients in different public and private medical settings. The study hypothesizes that doctors adopt a paternalistic model of interaction. The study finds that doctors exercise power when they interact with their patients as that most doctors adopt a paternalistic model of interaction, in which the doctor dominates the medical encounter. More academic research in this area is needed to be able to understand power and its impact on society in general and in medical settings in particular.

Keywords: power, doctor-patient interactions, paternalism, mutuality, consumerism.

Introduction

Language is considered the main tool by which people communicate with each other in a particular speech community. Scholars in a variety of disciplines investigate what interlocutors say in what communicative and strategic goals they attempt to achieve and the linguistic means they use to the establishment of the different social relations.

Power is one of the different social relations realized in daily face-to-face interactions. Cameron (2001:161) indicates that language "is among the social practices through which people enact relations of domination and subordination". Research on power in medical contexts is a relatively recent area of study and which attracted researchers 'attention in the last few decades. Mullany (2008:1) says that "overall, there is a real necessity for an empirical investigation to be produced in a wide variety of health care context ".

Many branches of study have incorporated the study of communication in medical contexts such as health literacy, applied linguistics, social psychology, and pragmatics. The doctor-patient interview as one type of medical context, in which the concept of power is said to manifest as a result of doctors interacting with patients, is the focus of the present study.

The doctor-patient relationship, with regard to power distribution, has taken on many transformations of the adopted model of interaction over the years. An often referred to typology is that of Roter and Hall (2006) which categorizes the models of doctor-patient interaction into paternalistic which is doctor-dominated, consumeristic which is patient-dominated, mutuality in which both doctor and patient participate actively in the interaction and default.

Statement of the problem

Based on the claim that there is no interaction without power (Bousfield and Locher, 2008: 8), power is a universal concept and is always present and can't be uprooted completely from society but one which is dynamic and negotiated in interaction (Foucault, 1980: 93). Thus, power constitutes an integral part of all social relationships; including doctor-patient interaction which is the focus of the present study. Nonetheless, not all doctor-patient encounters exhibit the same degree of power. Consequently, over the years, different manifestations of the distribution of power have been suggested that resulted in different models of doctor-patient interactions, whether doctor-dominated, patient-dominated or one in which both collaborate mutually. Some types of manifestations of power in doctor-patient encounters can have serious ramifications on the medical interview which can cause communication difficulties and eventually negatively affect patients' health outcomes.

Aim of the study

The present study aims at investigating the concept of power, its nature, and dynamics in Arabic doctor-patient encounters by establishing the type of model of interaction adopted in medical encounters.

Hypothesis

The present study hypothesizes that the model adopted in doctor-patient encounters is the paternalistic model of interaction in which the doctor dominates the encounter.

Power

The concept of power has been of interest to scholars in every discipline of social science, such as sociology, economics, philosophy, etc. Russell (1938:10) even claims that "the fundamental concept in social science is power, in the same sense in which energy is the fundamental concept in physics".

Power isn't an easy concept to understand and define due to its many changeable features, such as its instability and changeability (Foucault 1994:12). Yet, many definitions in the literature on power have been proposed. A classical definition of power is put forward by Weber(1947:152); he defines power as" the probability that one actor within a social relationship will be in a position to carry out his own will despite resistance, regardless of the basis on which this probability rests". Power has also been defined as "the ability to control resources, own and others', without social interference" (Galinsky, Gruenfeld and Magee, 2003: 454).

There have been many influential accounts that shaped the understanding of the nature of power in the literature. Machiavelli (1532) tackles the strategies people use in order to exercise and maintain power. Weber (1947), Dahl (1957), Bachrach and Baratz (1970), Foucault (1977) onward, Fairclough (1989), Wartenberg (1990) are only some of the vast number of scholars of the Twentieth Century who have dealt with power.

Types of Power

Many typologies of power have been proposed, such as:

French and Raven's Typology (1959)

French and Raven (1959) distinguish five types of power, namely:

1. Reward power: in which an individual says" A" has the capacity to reward another individual say "B" with what B desires or eliminate what B dislikes.
2. Referent power: where A identifies with B to be more like him by behaving, believing, and perceiving as A does.
3. Coercive power: where B expects to be punished by A if he doesn’t conform to what A desires.
4. Legitimate power: where A has a legitimate authority to request certain things from B on the basis that B accepts A's legitimacy according to some internalized values and beliefs.
5. Expert power: which stems from A's expertise, knowledge, practical skills, or cognitive abilities that B requires in a particular institution.

Brody's Typology (1992)

Another typology of power is specifically related to physicians' power in the field of medicine. A physician's power is said to consist of three elements which are:

1. Aesculapian power: is based on the physician's knowledge, experience, and skills which are believed to be independent of other variables such as status and class and which can be transferred from one physician to another who would consequently have similar experience and knowledge.
2. Charismatic power: is derived from the physician's personal traits such as decisiveness, courage, and kindness. This power is independent of the physician's medical knowledge and expertise and can't be transferred from one physician to another.
3. Social power: is based on a physician's social status. It is a kind of an implied agreement between the profession of medicine and society that gives physicians the authority to decide on the medical truth of those who come seeking medical care. This kind of power will be most prominent when the patient is of low "socio-economic" status (Brody, 1992: 16, 17).

Language and Power

An understanding of what holds power and language together needs to be made at this point. It is indicated that language is one of the most prominent tools through which the notion of power is exercised (Locher, 2004:34). Thus, power is realized through the use of language whether written or spoken. For example, political power is demonstrated through politicians' speeches, public debates, and elections' campaigns, and laws are demonstrated through written language (Thomas and Wareing, 2005: 10). Besides, Holmes and Stubbe (2015:3) claim that language is a substantial means of exercising power and a considerably necessary element in the creation of social reality. Since power is " the force in society that gets things done, and by studying it, we can identify who controls what, and for whose benefit" (Moore and Hendry, 1982: 127), it is argued then that language mostly benefits the interests of the more powerful groups of people since these are the people who are in charge and have authority over it (e.g. politicians, lawyers, and even parent, etc.) (Thomas and Wareing, 2005: 10). Fairclough (1989) has also pointed to the close relationship between language and power. His work gives important insights into power through language. He examines how the means by which individuals communicate are controlled by the structures and forces of the public institutions within which people live and function.

Models of Doctor-Patient Interactions

Research on the notion of power and its role in medical contexts has gradually attracted the attention of scholars in several different fields such as Pragmatics, Social Psychology, Clinical Linguistics, Medical Anthropology, etc. Yet, it is still a relatively new area of study.

Good doctor-patient communication and the vital role it plays in the enhancement of medical care delivery have been documented in many studies (Bertakis et al. 1991, Salmon et al.2000, Inui et al., 1982). This relationship is directly related to a patient's health and the effectiveness of both diagnosis and treatment (Kaba and Sooriakumaran, 2007: 57). One shared feature of the doctor-patient relationship is the difference in the distribution of power (Engel, 1989:73). This is because doctors have "legitimate", "referent" and "expert" power (Beisecker, 1990: 105). Some of the ways by which doctors express power are: avoiding to answer patient's direct questions about their medical condition, using "medical jargon" when talking to the patient, choosing not to inform patients about certain aspects of their condition (Skipper 1965, as cited in Philips, 1996:1419). Yet, some patients may not accept doctors' authority in an attempt to express their autonomy (Roter and Hall, 2006: 23). Patients might exercise power by asking questions, rejecting a particular treatment or test recommended by the doctor, insisting on a particular medical procedure, holding some important information away from the doctor (Roth 1963, as cited in, Roter and Hall, 2006: 25).

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