The Clinical Encounter and the Problem of Context

Abstract

The encounter between professional and patient is one of the basic units of analysis in the field of 'medical' sociology. From the very beginnings of the sociological investigation of medical practice it has been conceived as a dyadic encounter, defined by asymmetries of power, the negotiation of rational and authoritative scientific knowledge, and private, proximal, relations. This article argues for a more dynamic theoretical vision of the clinical encounter: one that shifts attention away from a Parsonian 'paradigm' of professional-patient interaction towards a perspective that incorporates the systemic changes that late modernity brings to medicine. The clinical encounter is no longer the dyadic system envisaged by Parsons, and his theoretical perspective -which has played an important part in framing sociological accounts of the practice of medicine -now needs to be reframed in relation to the organizing impulses of contemporary corporate professional practice. KEY WORDSdoctor-patient interaction / medical knowledge / medical practice / physician-patient relationship / Talcott Parsons

Information Infrastructures for eHealth

“…Digitalization will transform the existing relationships and institutions in healthcare. For example, electronic tools are changing the clinical encounter between a healthcare professional and a patient (May 2007;Winthereik 2008).…”

Managing Health(-Care Systems) Using Information Health Technologies

“…May [40] has noted that because of this diffusion, it is important that we no longer understand the patient-physician encounter as a privatised, dyadic and clearly locatable meeting: we must take into account the external regulators that interfere with and often even execute health deliverers' practices [40][41][42]. The contrast conducted in this study shows that this argument is certainly comprehensible in the case of England, but not fully applicable for the case of Germany.…”

“…Whereas that proved to be quite successful in England, the introduction of IHTs in Germany proved (and proves) to be a more difficult path, especially due to the highly decentralized system and, more specifically, many GPs' (often organized) interest in maintaining their therapeutic freedom and individual disease management strategies. The study thus shows that the way the patient-physician encounter has changed as described by May [40] is especially true for England's state-led healthcare systems.…”

The public, the private and the intimate in doctor–patient communication: Admission interviews at an outpatient mental health care service

“…Assuming his overall characterization of 'the organizing principles' (Heritage and Clayman, 2010: 119) of medical context, ethnographical descriptions are often missed or even underrepresented in specialized research. As Blommaert (2005: 51-52) notes, the combination of theoretical claims and prima facie ethnographic results, in many cases, in an a priori contextualization which situates verbal material within a static framework of 'non-discursive' situation (May, 2007). As a consequence, doctor-patient interaction appears framed in rough, schematic terms which ignore everyday negotiations of these roles, historical developments and traditions of health care, and ideological and political heterogeneity within the hospital's personnel, etc.…”