Professor Srikant Sarangi
8:30am - 4:30pm
Topic: Engaging Qualitatively with Healthcare Communication Data
2KW Rooftop Bar
5:00pm - 7:00pm
'Will you marry me'? The contingencies of communication ethics in healthcare practice and research
Healthcare delivery at organizational, clinical levels as well as the general conduct of healthcare research are increasingly being confronted with issues associated with everyday morality and professional ethics. Almost all aspects of healthcare practice and research – ranging from administration of consent forms to recruitment of participants for clinical trials to clinic encounters in the primary and tertiary sectors dealing with acute and chronic conditions – are underpinned by ethical and communicative challenges.
Topics such as individual autonomy, informed consent, patient-centredness, shared decision making call for different communicative frameworks, with attendant ethical imperatives. The prevailing ethical concerns have led to the establishment of principle-based codes of professional practice, although the parameters of ethical conduct in everyday clinical and research practice are much more nuanced at the role-relational and communicative levels. In arguing for a reappraisal of the core principles of ethics from a communication perspective, in this presentation I single out two key concepts – ‘self-other dynamics’ and ‘role-responsibility’ in relation to actions and accounts by both healthcare professionals and patients/carers – for particular attention. I outline a marriage proposal for two existing disciplines – communication and ethics – and empirically anchor my discussion in the context of healthcare encounters, e.g. recruitment of clinical trial participants and medical emergency calls.
Dignity in Work-integrated Learning: Creating, Maintaining, Protecting and Reclaiming Patient, Student and Educator Dignity
Work-integrated learning (WIL) in healthcare typically involves the triadic relationship between patient, student and educator.1 Dignity matters within such relationships: patients, students, and educators typically thrive when dignity is promoted but can suffer when dignity is violated.2 Although there are various ways of understanding dignity,3,4 it can be defined as: ‘how people feel, think and behave in relation to the worth or value of themselves and others’.5 While students, educators and patients often engage in purposeful acts of dignity promotion during WIL (so-called ‘dignity work’),6 violations of dignity (often involving communication violations) are sadly commonplace.2,6,7 Research has demonstrated a multiplicity of causes of both workplace dignity and dignity violations at the level of individuals (e.g. attitudes), relationships (e.g. communication) and organisation (e.g. hierarchy).2,7 Research has also illustrated various consequences of workplace dignity and dignity violations at individual (e.g. well-being), interpersonal (e.g. trust) and organisational levels (e.g. retention).2,7 In this keynote, Charlotte will draw on the published healthcare literature, including her own team-based research on dignity,2,4,7 to provide preliminary answers to five inter-related questions: (1) What is dignity and why does it matter in medical education? (2) How is the dignity of patients, students and educators commonly violated in healthcare learning, and how can dignity be created, maintained, protected and reclaimed instead? (4) What are the causes and consequences of workplace dignity and dignity violations? (5) How might we help patients, students, and educators to promote dignity? Charlotte hopes to stimulate lively debate during this COMET keynote about the theory, research and practice of WIL dignity.
1. Monrouxe LV, et al. (2009) The construction of patients’ involvement in hospital bedside teaching encounters. Qualitative Health Research 19(7), 918-930.
2. Monrouxe LV & Rees CE (2017) Healthcare professionalism: Improving practice through reflections on workplace dilemmas. Oxford: Wiley-Blackwell.
3. Bal M (2017) Dignity in the Workplace: New Theoretical Perspectives. Springer.
4. King O, et al. (under review) Dignity during work-integrated learning: what does it mean for supervisors and students? Manuscript under review.
5. Royal College of Nursing (2008) The RCN’s Definition of Dignity. London: RCN.
6. Jacobson N (2012) Dignity and Health. Nashville: Vanderbilt University Press.
7. Davis C, et al. (under review) Student dignity during work-integrated learning in higher education: A qualitative study exploring student and workplace supervisors’ perspectives in healthcare and non-healthcare disciplines. Manuscript under review
Patients Communicating with Practitioners about Social Problems: What Does Capitalism Have to Do with it?
We explore a question that has bothered me for a long time about patient-practitioner communication: What does capitalism have to do with it? My early research in this field grew from family experiences that focused on how my parents, brother, and I could obtain health care after we lost our health insurance when my dad lost his job after 25 years as an office worker. So I went into medicine partly for that reason and began to study communication, focusing initially on access barriers, information giving and withholding, and professional power. In quantitative work, we found that information giving occupied a very small part of medical encounters, much less than practitioners perceived, and that barriers communication related to gender, race, ethnicity, social class, and age. But in this quantitative work we uncovered a quandary that some of our most important observations involved the narratives exchanged between patients and practitioners about social problems. So we later applied qualitative analysis, based on critical literary theory, to transcripts from a random sample of our earlier recordings. We found that practitioners used a recurring conversational structure to marginalize social problems by moving the conversation away from them. Through comparative research in Cuba, we later learned that practitioners invoked an entirely different structure to confront the social problems that patients mentioned in medical encounters. In conclusion we explore how transformation of communication figures as one part of "moving beyond capitalism for our health."
Informed consent in an age of increasing complexity
Informed consent is the mechanism by which we ensure ethically acceptable medical practice, by ensuring a lack of deceit and coercion and protection of autonomy during decision-making. It is seen as a necessary, perhaps sufficient, ethical justification for actions that may affect people in both positive and negative ways, including medical treatment, research participation, and uses of human tissues.
It is important to consider the limitations of this approach, as well as its strengths. People giving consent to medical procedures are often in a vulnerable, powerless and compromised state, where they rely heavily on trusted health professionals to guide and protect them. Complex, unfamiliar concepts that are laced with probabilities may well be overwhelming. Novel, emerging treatments may evoke desperate and unrealistic hope in people facing significant morbidity or death. Financial constraints may make research participation an attractive way to gain access to expensive treatments. Subtle and often unintended messages communicated by health professionals through their use of words and the context in which they deliver them (the mantle of medical science), can put pressure on people to agree to actions not concordant with their values. The more complex the choices, and the less certain the outcomes, the more difficult this all becomes. This presentation will discuss the limitations and strengths of informed consent, and the ways in which we might respond to them.