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The informative process in medical care: A preliminary report with implications for instructional communication

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Abstract

This paper presents a summary of an on-giing research project concerned with doctor-patient communications. Of specific interest are doctors' communications of information about illness to the patient. The communication of information in medical care situations is considered to be, at certain levels, analogous to the purposive, instructional communications in education.

Sociological considerations guiding this research are summarized under four headings: (1) problems of uncertainly and power; (2) the definition of information; (3) sociolinguistics and the diffidence of the sick poor; and, (4) ethnomethodology and common sense constructs. The doctor-patient relationship is viewed as a micro-political situation in which information control is used, at least in part, to maintain patterns of dominance and subordination.

The overall methodological objective of this research is to develop a research design, linked to these research objectives, which allows reproducible and generalizable conclusions about the informative process in a variety of clinical settings. This preliminary paper includes a discussion of technical problems arising from the study of doctor-patient relationships and communications; preliminary results of studies of non-verbal communication; and, qualitative themes in the informative process.

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Authors and Affiliations

  1. La Clinica de la Raza, Oakland, Ca., U.S.A.

    Howard Waitzkin

  2. Department of Medicine, Harvard School of Medicine, Boston, Mass., U.S.A.

    John D. Stoeckle

  3. Massachusetts General Hospital, Boston, Mass., U.S.A.

    John D. Stoeckle

  4. Yale Law School, New Haven, Conn., U.S.A.

    Eric Beller

  5. Boulder Creek, Ca., U.S.A.

    Carl Mons

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  1. Howard Waitzkin
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  4. Carl Mons
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Additional information

This report is based on Working Papers 3, 4, 6, 8 and 9, which were prepared as part of the research project, “The Informative Process in Medical Care”, sponsored by grants HS 01565 and 5F01HS54-957 from the National Center for Health Services Research, and by Robert Wood Johnson Foundation Clinical Scholars Program at Stanford University. Portions of this report were presented at the Annual Meeting of the Clinical Scholars Program, Rye, NY, April 1975. Acknowledgments: W. Richard Scott has participated as Co-Principal Investigator of this research project. Elliot G. Mishler provided valuable critical advice. Sandra Chapek, June Fisher, Terence Fried, Alison Harlow, Viviane Nathan, Bonnie Obrig, and Beverly Russell also made important contributions.

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Waitzkin, H., Stoeckle, J.D., Beller, E. et al. The informative process in medical care: A preliminary report with implications for instructional communication. Instr Sci 7, 385–419 (1978). https://doi.org/10.1007/BF00121641

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