Bridging the discursive gap between lay and medical discourse in care coordination

Datos Bibliográficos

ID2249255
AutoresRod Sheaff (0000-0002-7984-2627, School of Government Plymouth University UK, autor de correspondencia), Joyce Halliday (School of Government Plymouth University UK), Richard Byng (0000-0001-7411-9467, School of Medicine and Dentistry Plymouth University UK), John Øvretveit (0000-0001-9668-0175, LIME/MMC Karolinska Institutet Stockholm Sweden), Mark Exworthy (0000-0003-4791-7513, Health Services Management Centre University of Birmingham UK), Stephen Peckham (0000-0002-7002-2614, Centre for Health Services Studies University of Kent UK), Sheena Asthana (0000-0002-1483-2719, School of Government Plymouth University UK)
Año2017
Volumen39
Número7
Páginas1019-1034
Fecha de publicación2017-09-01
Peer ReviewedSí
Open AccessSí
TipoARTICLE
RevistaSociology of Health & Illness (JOURNAL)
Identificadores de la revistaISSN: 0141-9889 • E-ISSN: 1467-9566
EditorialWiley (PUBLISHER • GB)
DOI10.1111/1467-9566.12553
PMID28349619
OpenAlexW2603309613
IdiomaEN
Citas recibidas6
Referencias citadas78

For older people with multiple chronic co-morbidities, strategies to coordinate care depend heavily on information exchange. We analyse the information-sharing difficulties arising from differences between patients' oral narratives and medical sense-making; and whether a modified form of 'narrative medicine' might mitigate them. We systematically compared 66 general practice patients' own narratives of their health problems and care with the contents of their clinical records. Data were collected in England during 2012-13. Patients' narratives differed from the accounts in their medical record, especially the summary, regarding mobility, falls, mental health, physical frailty and its consequences for accessing care. Parts of patients' viewpoints were never formally encoded, parts were lost when clinicians de-coded it, parts supplemented, and sometimes the whole narrative was re-framed. These discrepancies appeared to restrict the patient record's utility even for GPs for the purposes of risk stratification, case management, knowing what other care-givers were doing, and coordinating care. The findings suggest combining the encoding/decoding theory of communication with inter-subjectivity and intentionality theories as sequential, complementary elements of an explanation of how patients communicate with clinicians. A revised form of narrative medicine might mitigate the discursive gap and its consequences for care coordination

Epistemology · Health care · Linguistics · Medical record · Narrative · Narrative medicine · Political science · Subjectivity · Viewpoints · Chronic Disease Management Strategies · Law · Medicine · Mental Health and Psychiatry · Patient-Provider Communication in Healthcare · Psychology