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Communicative construction of native versus non-native Swedish speaking patients in consultation settings
Jönköping University, School of Education and Communication, HLK, Lifelong learning/Encell.
Gothenburg Research Institute (GRI), School of Business, Economics and Law, Universi-ty of Gothenburg .
Sophiahemmet University.
2013 (English)In: Offentlig Förvaltning. Scandinavian Journal of Public Administration, ISSN 2000-8058, E-ISSN 2001-3310, Vol. 17, no 4, 21-49 p.Article in journal (Refereed) Published
Abstract [en]

In this paper, we examine patient-centered care through analyzing communicative constructions of patients, on the basis of their native language, in consultations with physicians. Whereas patient-centered care is of current interest in health care, research has not addressed its implications in this dimension. Previous studies indicate that non-native Swedish speaking patients, experience substandard interpersonal treatment far more than native Swedish speaking patients. Our findings show that the non-native Swedish speaking patients presented themselves as participating, whereas the native Swedish speaking patients presented themselves as amenable. The physicians responded in two different ways, argumentatively towards the non-native Swedish speaking patients and acknowledging vis-à-vis the native Swedish speaking patients. When decisions and conclusions were made by the patients and physicians, this resulted in preservation of the status quo in the consultations with the non-native Swedish speaking patients, while the corresponding result with the native Swedish speaking patients was monitoring of their health status. So, whereas the non-native Swedish speaking patients actually were model patient-centered care patients, physicians were more amenable towards the native Swedish speaking patients. We suggest that patient-centered care is desirable, but its practical application must be more thoroughly scrutinized from both a patient and a health care worker perspective.

Place, publisher, year, edition, pages
2013. Vol. 17, no 4, 21-49 p.
Keyword [en]
communication, critical discourse analysis, dialogue, health care, patient-centered care
National Category
Pedagogy
Identifiers
URN: urn:nbn:se:hj:diva-23620OAI: oai:DiVA.org:hj-23620DiVA: diva2:705744
Available from: 2014-03-17 Created: 2014-03-17 Last updated: 2014-08-20Bibliographically approved
In thesis
1. The production and maintenance of inequalities in health care: A communicative perspective
Open this publication in new window or tab >>The production and maintenance of inequalities in health care: A communicative perspective
2014 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

The Swedish health care system does not offer care on equal terms for all its end-users. Discrimination toward patients can take the form substandard communication toward women or foreign born patients. Discrimination is also embedded in the organizational context. Health care is under pressure to increase efficiency and quality of care at the same time. There is a risk that demands for equality will be pushed aside. This thesis aims to contribute to our understanding of how discrimination is expressed in interpersonal- and organizational communication within health care, and highlight educational implications for health care practices. This thesis is comprised of three empirical studies and one conceptual study. In the first study, critical discourse analysis (CDA) is used to categorize gender patterns in communication between health care workers and patients, and finds that both patients and health care workers reproduced the gender order. Open questions created a setting less prone to be limited by gender stereotypes. In the second study, CDA is used and complemented with Linell’s dialogic perspective in order to explore whether patients who were native speakers of Swedish were constructed differently than those who were not, in patient-physician consultations. Findings indicated that the non-native speakers actually were model, participative patients according to patient-centered care. Notwithstanding this they were met by argumentation, whereas the more amenable native patients were met by accommodating responses. In the third study, qualitative content analysis is used to analyze how health care workers talked about patients in their absence. The results revealed that communication about patients who were perceived as not acting according to socially accepted gender norms contained negative and disparaging statements. The final study focused on Clinical Microsystems, a New Public Management-based model for multi-professional collaboration and improvement of health care delivery. Drawing on theories of New Public Management, gender, and organizational control, this study argues that the construction of innovative and flexible health care workers risks reproducing the gender order. The thesis concludes that gender and ethnic stereotypes are reproduced in health care communication, and that an efficiency-inspired organizational and institutional discourse may be an impediment to equal care. This calls for focus on learning about communication for prospective and existing health care workers in a multicultural health care context.

Place, publisher, year, edition, pages
Jönköping: School of Education and Communication, Jönköping University, 2014. 179 p.
Series
Doktorsavhandlingar från Högskolan för lärande och kommunikation, ISSN 1652-7933 ; 26
Keyword
communication, gender, ethnicity, health care, organization, critical discourse analysis, social constructionism, social positions, qualitative content analysis
National Category
Pedagogy
Identifiers
urn:nbn:se:hj:diva-24380 (URN)978-91-628-9074-2 (ISBN)978-91-628-9076-6 (digitalt) (ISBN)
Public defence
2014-09-12, Hb116, Högskolan för lärande och kommunikation, Jönköping, 13:15 (Swedish)
Opponent
Supervisors
Available from: 2014-08-20 Created: 2014-08-20 Last updated: 2014-08-21Bibliographically approved

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