Language barriers in healthcare delivery

The relevance of language for quality healthcare delivery cannot be overemphasised. Within the framework of communication accommodation theory, this paper discusses language barriers in expatriate doctor–patient communication in three state-owned hospitals in Ghana, and the strategies employed by the medical personnel to bridge communication gaps. The study design is qualitative and the data were obtained through semi-structured interviews with 16 expatriate doctors, three nurses and three patients. Furthermore, observation of five patient–doctor interactions was undertaken and notes taken. Both datasets were then analysed using the qualitative conventional content analysis approach. The findings revealed that the expatriate doctors employed convergence strategies such as ad hoc interpreters, gestures, picture charts and electronic dictionaries to deal with language barriers. The study is expected to stimulate further research into innovative ways of dealing with language barriers in expatriate doctor–patient interactions.

Branding hospitals on social media through health professionals

Hospitals are facing a constantly changing context in which patients are becoming more demanding, public health education initiatives are regarded as increasingly important and hospital business models have to take account of constantly developing medical technologies. In order to better interact with internal and external stakeholders, hospitals try to reinforce their corporate communication strategies as well as their brand reputation by means that include using social media platforms. This literature review paper aims to better understand why health professionals have the potential to play a key role in hospitals’ branding initiatives through social media. First, I report the findings from studies of concepts related to corporate communication, branding and the connection between social media and personal branding; and, second, I propose a communication model – what I call the PMA branding model – to help hospitals build a brand reputation based on health professionals’ participation in corporate communication initiatives led by hospitals on social media. The paper concludes by showing that the PMA branding model consists of organisational tools based on a rigorous methodology that will help health professionals participate in branding initiatives led by the hospital through these platforms.

Interaction between patient and health professional

This article presents a theoretical view on culturally embedded thinking and action in encounters between patient and health professional. A key point of the analysis indicates that a highly efficient health sector may entail an implicit duality: on the one hand, the health professional can and often must relate pragmatically to the patient in order to solve problems and do so quickly, while on the other, the professional may be personally challenged when embedded cultural thinking leads to conflicts or dilemmas. This means that a purely pragmatic perspective will be challenged when such conflicts arise. The article looks at interrelated concepts such as ‘culture’, ‘prejudice’ and ‘meaning’ in order to shed light on the presuppositions that are brought into the cultural encounter between patient and health professional. This kind of analysis will hopefully contribute to a raised awareness of what is actually – apart from pragmatic problem solving – going on in such encounters. The conceptual framework used in this article primarily draws on the German philosopher Hans-Georg Gadamer, which is contrasted with the pragmatic perspective from the American philosopher Richard Rorty.

‘No problem’ advice during occupational health examinations

In many countries, occupational health examinations are considered to have a central role in ensuring that employees’ health and work ability are maintained or enhanced. In contemporary Finland, the institutional goal of these examinations is to construct a health plan based on the client’s own aims, and in this paper we analyse how occupational health nurses and clients in Finland negotiate what is considered to be a problem. The data consist of 10 video-recorded occupational health examination encounters, analysed by means of conversation analysis. Our analysis focuses on ‘no problem’ advice, in which the advice giving is initiated in the absence of a problem-indicative response. The client’s ‘no problem’ response was typically followed by the nurse upgrading the problem that she had identified and giving a general reminder of a possible problem. The clients resisted not so much the content of the advice, but the act of advising itself. In a few cases, the client’s ‘no problem’ response was followed by a turn in which the nurse contested the client’s knowledge and offered advice that was tailored to the client’s situation. The client acknowledged the advice as new information. Our findings indicate that regardless of client-centred ideals, the interaction in occupational health examinations is largely led by nurses, who set up the agenda and raise issues that they consider to be problems for their clients.

Reporting on individual experience

This paper proposes a new model for a patient-centred medical case report. Patient-centred approaches adopt the patient’s perspective and emphasise the individual’s experience of illness, and are intended to answer criticisms that medical texts for professionals, by focusing solely on a disease phenomenon presented within a framework of biomedical reasoning, depersonalise the patient and fail to engage in patient advocacy. The paper provides a systematic review of the most important strands in research on medical case reporting, taking a socio-cultural approach that focuses specifically on the evolution of the genre and on existing examples of patient-centredness that could form a basis for the new model. The aim here is to offer the first systematised proposal containing guidelines already available in the literature, as well as to provide recommendations on how to write about patients in medical case reports in way that does not depersonalise them.

Metadiscourse, materiality and morality in communication skills training with simulated patients

Simulated patients (also known as standardized patients) are commonly employed by institutions of medical education to train medical students and assess their communication skills. This article demonstrates that such patients are not translational devices that enact prima facie standards of communication skills as laid out by the institutions that use them, but rather metadiscursively transform communication practices. This is shown via a case study that closely examines a series of interactions between a simulated patient and a third-year medical student during a practice exam designed for the United States Medical Licensing Examination Step 2 Clinical Skills. I use discourse analysis to show how communication skills are transformed in three practices: (1) simulated consultations between standardized patients and medical students; (2) spoken evaluations offered by standardized patients after simulated consultations between standardized patients and medical students; and (3) written evaluations offered by standardized patients in assessment forms. In particular, by attending to how a simulated patient makes the act of draping the patient a relevant communication skill, I explicate the material elements and moral implications of clinical communication. Finally, I consider the instructive role simulated patients play in medical education and how their standards build on and often stand in contrast to communication skills techniques. I conclude by making practical suggestions for communication skills training with simulated patients in medical education.

Opening up space for compassion in nurses’ handover meetings

In this paper, we complement research into compassion in medical contexts with an analysis of the representation of patients in nursing handovers and the ways in which such practitioner–practitioner interaction can be said to demonstrate and evoke feelings of compassion towards patients. We label such representation as ‘Compassion Talk’ and suggest that potentially it can complement the information given as part of the standard format for handovers. The analysis is based on instances of non-scripted talk (NST) from three nursing handover meetings from a highly performing Medical Assessment Unit in the UK. In a data-led qualitative analysis, we find that within NST patients are represented in terms that not only make nurses’ actions to alleviate their suffering seem possible and necessary, but that also highlight their shared humanity and position the patients as if they are members of the nurses’ wider social group. We further demonstrate how NST can be successfully managed by experienced nursing staff and suggest, therefore, that handovers can function not only to pass on information accurately and concisely, but also as a space for nurses to regroup as a community of practice and to relate to their patients in human terms, as a defining principle of the profession.

‘We all have friends like that’

Medical professionals are in an ideal position to mediate between the benefits and harms of internet-sourced medical information, but there is reluctance by patients to discuss with their doctors information found online. This is the first study undertaken in a rural Australian context, where service limitations mean patients’ use of the internet may be especially important. Patients attending general practice clinics (n = 33) were interviewed to discover how they used the internet for health information and how they discussed this with their doctors. Analysis used a constant comparison method, informed by grounded theory and a dramaturgical framework. Most participants used a range of tactics when discussing internet-sourced medical information, including concealment, disguise or upfront apologetic disclosures to avoid undermining the expertise of the doctor. These findings do not confirm predictions made in the past that patients’ acquisition of internet health information would alter the power dynamic of the medical consultation. Potentially, proactive, doctor-initiated inquiry about internet medical information may help to normalise patients’ internet use, allowing open discussion, so doctors can maximise benefits and reduce harms of internet health information. Further study is required to see if this will be an effective strategy and impact health outcomes.

Change in Family Therapy

A fundamental theoretical premise in Structural Family Therapy (SFT) is that changes in individual members and improvements in intra-familial relations are realized by repairing the family structure. Dysfunctional families are conceptualized in terms of individuals taking on inappropriate roles (e.g., children acting as if they were parents) and the boundaries between parental executive levels and the children/sibling level are unclear, too rigid, or highly permeable. The therapist’s role is to temporarily engage (join) with family members in a way that generates in-session interactions that exemplify the desirable family structure. While the theory supporting these interventions are well developed, there has been little work done on explicating how such tasks may be interactively accomplished in clinical practice. Drawing from the methods of conversation analysis, our aim for this paper is to show how a master therapist in SFT accomplishes some of these transformations during a single therapy session. We focus on the discursive resources through which the therapist is able to readjust the role relationships between a mother and her daughter (i.e., in such a way that the mother can adopt a more agentive position vis-a-vis her children) and how the therapist’s actions indexed core SFT principles of restructuring the family.

Starting points for therapeutic change

Based on a corpus of 70 tape-recorded therapy sessions (client-centered therapy, psychodynamic therapy), this paper presents analyses of therapists’ interventions that have the potential to trigger change processes. Using a conversation analytic approach, we identify utterances that re-formulate the patient’s experience from a different perspective. In a second step, we draw on concepts from cognitive and pragmatic linguistics, mainly “frame” and “category”, to analyze the conceptual side of these rewordings. We show that, besides processes of general abstraction, the conceptualization of the patient’s experience from a societal perspective is a crucial part of the rewordings. The verbal re-framing creates a potential for accessing stocks of societal knowledge that would not have been accessible based on the patient’s initial, individualistic and often erratic presentation of events. By changing the wording an experience is referred to, the therapist thus creates links to established collective knowledge about experiences of this category. Once such links to collective knowledge have been created, it then becomes possible to understand differently how the experience in question came to pass, which features it is characterized by and how it can be dealt with in a way that is collectively known to be helpful.