Healthcare providers’ narratives about interactionally troubling patient exchanges: Accounting for and against an active patient role

Submitted: 26 September 2023
Accepted: 2 April 2024
Published: 4 July 2024
Abstract Views: 296
PDF: 175
Publisher's note
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.

Authors

The current trend in healthcare is to actively involve patients in their own treatment; however, in practice, healthcare providers may adhere to paternalistic views, which may not align with ideals related to patient involvement. This tension may become visible when providers talk about service encounters that they experienced as being interactionally troubling. In this empirical qualitative study, we utilize Bamberg’s narrative positioning analysis to explore how healthcare providers construct patients’ roles in narratives about such troubling exchanges. Data consist of 20 audio-recorded interviews with healthcare providers. We found two types of narratives in which healthcare providers’ perceptions of interactionally troubling patient exchanges were consistently related to their implicit evaluations of patients along a continuum of activeness versus passiveness. In the first, an active patient was considered ideal, and the problematic patient was one who is passive. In the second, a patient’s over-activeness was thought to interfere with the healthcare delivery. While providers’ complaints about patient passiveness were unproblematically presented from the perspective of the patient participation ideal, complaints about patient over-activeness were difficult to account for due to their inherent connotations with paternalism. Thus, we conclude that there is a need for training and interventions aiming to develop healthcare providers’ critical awareness of shifting cultural models, including patient involvement ideals and providers’ capacity to reflect paternalistic tendencies.

Dimensions

Altmetric

PlumX Metrics

Downloads

Download data is not yet available.

Citations

Anthony, P., & Crawford, P. (2000). Service user involvement in care planning: The mental health nurse’s perspective. Journal of Psychiatric and Mental Health Nursing, 7, 425–434. DOI: https://doi.org/10.1046/j.1365-2850.2000.00332.x
Bamberg, M. (1997). Positioning between structure and performance. Journal of Narrative and Life History, 7(1–4), 335–342. DOI: https://doi.org/10.1075/jnlh.7.1-4.42pos
Bamberg, M. (2004). Positioning with Davie Hogan. Stories, tellings, and identities. In Daiute, C., & Lightfoot, C. (Eds.), Narrative Analysis: Studying the Development of Individuals in Society (pp. 135–157). Sage. DOI: https://doi.org/10.4135/9781412985246.n23
Barnes, S. E., & Ferguson, A. (2012). Speakership asymmetry during topic talk involving a person with aphasia. Journal of Interactional Research in Communication Disorders, 3(1), 27–46. DOI: https://doi.org/10.1558/jircd.v3i1.27
Brookes, G., McEnery, T., McGlashan, M., Smith, G. M., & Wilkinson, M. (2022). Narrative evaluation in patient feedback: A study of online comments about UK healthcare services. Narrative Inquiry, 32, 9–35. DOI: https://doi.org/10.1075/ni.20098.bro
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 in Medicine, 44, 681–692. DOI: https://doi.org/10.1016/S0277-9536(96)00221-3
Clift, R. (2016). Conversation Analysis. Cambridge University Press. DOI: https://doi.org/10.1017/9781139022767
Crawford, M. J., Rutter, D., Manley, C., Weaver, T., Bhui, K., Fulop, N., & Tyrer, P. (2002). Systematic review of involving patients in the planning and development of health care. British Medical Journal, 325(7375), 1263. DOI: https://doi.org/10.1136/bmj.325.7375.1263
Cui, X. (2014). Getting to the source: Dynamics of problematic interactions. RELC Journal, 45, 197–210. DOI: https://doi.org/10.1177/0033688214535053
Denniston, M. E., & Rees, C. E. (2018). “I will never ever go back”: Patients’ written narratives of health care communication. Medical Education, 52, 757–771. DOI: https://doi.org/10.1111/medu.13612
Drew, P., & Holt, E. (1988). Complainable matters: The use of idiomatic expressions in making complaints. Social problems, 35(4), 398–417. DOI: https://doi.org/10.1525/sp.1988.35.4.03a00060
Egbert, M., & Deppermann, A. (2012). Hearing aids communication: Integrating social interaction, audiology and user centered design to improve communication with hearing loss and hearing technologies. Verlag für Gesprächsforschung.
Ekberg, K., Hickson, L., & Grenness, C. (2017). Conversation breakdown in the audiology clinic: The importance of mutual gaze. International Journal of Communication and Language Disorders, 52(3), 346–355. DOI: https://doi.org/10.1111/1460-6984.12277
Epstein, R. M., Franks, P., Fiscella, K., Cleveland, G. S., Meldrum, S. C., Kravitz, R. L., & Duberstein, P. R. (2005). Measuring patient-centred communication in patient-physician consultations: Theoretical and practical issues. Social Science & Medicine, 61, 1516–1528. DOI: https://doi.org/10.1016/j.socscimed.2005.02.001
Goodwin, C. (1995). Co-constructing meaning in conversation with an aphasic man. Research on Language and Social Interaction, 28(3), 233–260. DOI: https://doi.org/10.1207/s15327973rlsi2803_4
Goodwin, C. (2013). The co-operative, transformative organization of human action and knowledge. Journal of Pragmatics, 46(1), 8–23. DOI: https://doi.org/10.1016/j.pragma.2012.09.003
Jovchelovitch, S., & Bauer, M. W. (2000). Narrative interviewing. In M. W. Bauer, & G. Gaskell (Eds.), Qualitative Researching with Text, Image and Sound: A Practical Handbook for Social Research (pp. 57–74). Sage. DOI: https://doi.org/10.4135/9781849209731.n4
Kalitzkus, V., & Matthiessen, P. F. (2009). Narrative-based medicine: potential, pitfalls, and practice. The Permanente Journal, 13(1), 80. DOI: https://doi.org/10.7812/TPP/09.996
Kurhila, S. (2006). Second language interaction. John Benjamins. DOI: https://doi.org/10.1075/pbns.145
Kwame, A., & Petrucka, P. M. (2021). A literature-based study of patient-centered care and communication in nurse-patient interactions: Barriers, facilitators, and the way forward. BMC nursing, 20(1), 158. DOI: https://doi.org/10.1186/s12912-021-00684-2
Laakso, M. (2012). Aphasia as an example of how a communication disorder affects interaction. In M. Egbert, & A. Deppermann (Eds.), Hearing aids communication (pp. 138–145). Verlag für Gesprächsforschung.
Linell, P. (1998). Approaching dialogue: Talk, interaction and contexts in dialogical perspectives. Amsterdam: John Benjamins Publishing. DOI: https://doi.org/10.1075/impact.3
Lind, C., Hickson, L., & Erber, N. P. (2004). Conversation repair and acquired hearing impairment: A preliminary quantitative clinical study. Australian and New Zealand Journal of Auciology, 26(1), 40–52. DOI: https://doi.org/10.1375/audi.26.1.40.55987
Lindström, J., & Karlsson, S. (2016). Tensions in the epistemic domain and claims of no-knowledge: A study of Swedish medical interaction. Journal of Pragmatics, 106, 129–147. DOI: https://doi.org/10.1016/j.pragma.2016.07.003
Lord, L., & Gale, N. (2014). Subjective experience or objective process: Understanding the gap between values and practice for involving patients in designing patient-centred care. Journal of Health Organization and Management, 28(6), 714–730. DOI: https://doi.org/10.1108/JHOM-08-2013-0160
McCalman, J., & Potter, D. (2015). Leading Cultural Change: The Theory and Practice of Succesful Organizational Transformation. Kogan Page.
McColl-Kennedy, J. R., Vargo, S. L., Dagger, T. S., Sweeney, J. C., & Kasteren, Y. V. (2012). Health care customer value cocreation practice styles. Journal of Service Research, 15(4), 370–389. DOI: https://doi.org/10.1177/1094670512442806
Olakivi, A., Stevanovic, M., Nevalainen, H., Henttonen, P., & Ravaja, N. (2024). Voicing experiences of ageist nonrecognition in performance appraisal interaction: Complexities in constructing stories that counteract organisational ignorance. Culture and Organization, 1–21. DOI: https://doi.org/10.1080/14759551.2024.2332646
Pajo, K. (2013). The occurrence of ‘what’, ‘where’, ‘what house’ and other repair initiations in the home environment of hearing-impaired individuals. International Journal of Language and Communication Disorders, 48(1), 66–77. DOI: https://doi.org/10.1111/j.1460-6984.2012.00187.x
Pomerantz, A. (1986). Extreme case formulations: A way of legitimizing claims. Human Studies, 9(2–3), 219–229. DOI: https://doi.org/10.1007/BF00148128
Rodriguez-Bailon, M., López-González, L., & Merchán-Baeza, J. A. (2022). Client-centred practice in occupational therapy after stroke: A systematic review. Scandinavian Journal of Occupational Therapy, 29(2), 89–103. DOI: https://doi.org/10.1080/11038128.2020.1856181
Roter, D. (2000). The enduring and evolving nature of the patient-physician relationship. Patient Education and Counseling, 39, 5–15. DOI: https://doi.org/10.1016/S0738-3991(99)00086-5
Ruusuvuori, J., Asmuß, B., Henttonen, P., & Ravaja, N. (2019). Complaining about others at work. Research on Language and Social Interaction, 52(1), 41–62. DOI: https://doi.org/10.1080/08351813.2019.1572379
Sanerma, P., Miettinen, S., Paavilainen, E., & Åstedt-Kurki, P. (2020). A client-centered approach in home care for older persons – An integrative review. Scandinavian Journal of Primary Health Care, 38(4), 369–380. DOI: https://doi.org/10.1080/02813432.2020.1841517
Stevanovic, M. (2018). Social deontics: A nano‐level approach to human power play. Journal for the Theory of Social Behaviour, 48(3), 369–389. DOI: https://doi.org/10.1111/jtsb.12175
Stevanovic, M., Valkeapää, T., Weiste, E., & Lindholm, C. (2020). Promoting client participation and constructing decisions in mental health rehabilitation meetings. In C. Lindholm, M. Stevanovic & E. Weiste (Eds.), Joint decision making in mental health: An interactional approach (pp. 43–68). Palgrave Macmillan. DOI: https://doi.org/10.1007/978-3-030-43531-8_2
Stevanovic, M., Olakivi, A., Nevalainen, H., Henttonen, P., & Ravaja, N. (2024). Telling a supervisor about experiences of gendered dismissal: Problems of documentation, tellability, and failed authority. Gender, Work & Organization, 31(2), 554–575. DOI: https://doi.org/10.1111/gwao.13088
Sweeney, J. C., Danaher, T. S., & McColl-Kennedy, J. R. (2015). Customer effort in value cocreation activities: Improving quality of life and behavioral intentions of health care customers. Journal of Service Research, 18(3), 318–335. DOI: https://doi.org/10.1177/1094670515572128
Thompson, A. G. H. (2006). The meaning of patient involvement and participation in health care consultations: A taxonomy. Social Science & Medicine, 64, 1297–1310. DOI: https://doi.org/10.1016/j.socscimed.2006.11.002
Vrangbaek, K. (2015). Patient involvement in Danish health care. Journal of Health Organization and Management, 29(5), 611–624. DOI: https://doi.org/10.1108/JHOM-01-2015-0002
Weiste, E., Käpykangas, S., Uusitalo, L.L., & Stevanovic, M. (2000). Being heard, exerting influence, or knowing how to play the game? Expectations of client involvement among social and health care professionals and clients. International Journal of Environmental Research and Public Health, 17(16), 5653. DOI: https://doi.org/10.3390/ijerph17165653
Weiste, E., Ranta, N., Stevanovic, M., Nevalainen, H., Valtonen, A., & Leinonen, M. (2022). Narratives about negative healthcare service experiences: Reported events, positioning and normative discourse of an active client. Healthcare, 10(12), 2511. DOI: https://doi.org/10.3390/healthcare10122511

Supporting Agencies

European Social Fund, Academy of Finland

How to Cite

Weiste, Elina, Melisa Stevanovic, Nanette Ranta, and Henri Nevalainen. 2024. “Healthcare providers’ Narratives about Interactionally Troubling Patient Exchanges: Accounting for and Against an Active Patient Role”. Qualitative Research in Medicine and Healthcare 8 (2). https://doi.org/10.4081/qrmh.2024.11877.