Information control and the micropolitics of health care: Summary of an ongoing research project

doi:10.1016/0037-7856(76)90070-6

Social Science & Medicine (1967)

Volume 10, Issue 6, June 1976, Pages 263-276

https://doi.org/10.1016/0037-7856(76)90070-6 Get rights and content

Abstract

Policy changes suggested by “macro” research on the medical care system will not in themselves correct critical gaps and misunderstandings that persist at the “micro” level of the doctor-patient relationship. This paper presents a summary of an ongoing research project concerning one element of this relationship—the doctor's communication of information about illness to the patient.

Information transmittal is closely related to the clinical problems of history taking, medical records, compliance, satisfaction, physiologic response to therapy and patient delay in reporting symptoms.

The sociological considerations guiding the research are summarized under four headings: (1) the problems of uncertainty 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 micropolitical situation, in which information control is used, at least in part, to maintain patterns of dominance and subordination.

The over-all methodological objective of the research project is to develop a research design, linked to these sociological perspectives, which allows reproducible and generalizable conclusions about the informative process in a variety of clinical settings. Based on a pre-test,a multivariate model has been operationalized; an association is hypothesized between transmitted information—the dependent variable—and several independent variable, which are classified as physician characteristics, patient characteristics, and situational characteristics. The measures of the dependent and independent variables, sampling procedures, and approach to data analysis are described. Questionnaire materials are presented in appendices.

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^☆: This report is based on Working Paper No. 9, which was 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 the Robert Wood Johnson Foundation Clinical Scholars Program at Stanford University. Portions of the report were presented at the Annual Meeting of the Clinical Scholars Program, Rye, New York, April, 1975.

View full text

Information control and the micropolitics of health care: Summary of an ongoing research project☆

Abstract

Ped. Cl. N. Am.

Soc. Sci. & Med.

Human Relations and Hospital Care

The Patient's Attitude to Nursing Care

Sickness and Society

Essays on The Welfare State

Hospitals and Me Don't Take: A Participant Observation Study of Physically Ill Adolescents

Truth's search for power: The dilemmas of the social sciences

Soc. Probl.

Caring for the patient

New Engl. J. Med.

Should the patient be told the truth?

Communication with the Fatally Ill

Critique of Practical Reason

The use of truth and falsehood in medicine: An experimental study

Am. Med.

Ethical forces in the practice of medicine

Social Service and the Art of Healing

The Meaning of Right and Wrong

Explaining to the patient: A therapeutic tool and a professional obligation

J.A.M.A.

Morals and Medicine

The education of the physician-investigator

Daedalus

The self-image of the physician and the care of dying patients

Ann. N.Y. Acad. Sci.

Should doctors tell the truth?

Harper's Mag.

Physician and patient as a social system

New Engl. J. Med.

Be an optimist

J. Mt. Sinai Hosp.

A modern religio medici: Sir Thomas Browne

Br. Med. J.

The communication of information about illness: Clinical, sociological and methodological considerations

Adv. Psychosom. Med.

The Exploitation of Illness in Capitalist Society

Medical Records, Medical Education and Patient Care

Variations in patients' compliance with doctors' advice: An empirical analysis of patterns of communication

Am. J. publ. Hlth

Gaps in doctor-patient communication: Patients' response to medical advice

New Engl. J. Med.

Variation in patients' compliance with doctors' orders: Medical practice and doctor-patient interaction

Psychiat. Med.

The clinical picture of diabetes control, studied in four settings

Am. J. publ. Hlth

Patient compliance

New Engl. J. Med.

Effects of Post-Graduate Physician Education on the Management and Outcomes of Patients with Hypertension

Gaps in doctor-patient communication: Doctor-patient interaction and patient satisfaction

Pediat.

Doctor-patient communication

Sci. Am.

Psychological Stress: Psychoanalytic and Behavioral Studies of Surgical Patients

Reduction of post-operative pain by encouragement and instruction of patients

New Engl. J. Med.

Children, stress, and hospitalization: A field experiment

J. Hlth Soc. Behav.

Patient delay in cancer

New Engl. J. Med.

Dial access library—Patient information service: An experiment in health education

New Engl. J. Med.

Genetic counseling: A consumers' view

New Engl. J. Med.

The “bad” patient gets better quicker

Soc. Policy

Strategies and tactics of mothers of mentally retarded children for dealing with the medical care system

Giving the patient his medical record: A proposal to improve the system

New Engl. J. Med.

Informed consent: New rule puts burden of proof on patients

Mod. Hosp.

Informed (but uneducated) consent

New Engl. J. Med.