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Photographs included in the original manuscript have been reproduced xerographically in this copy. Higher quality 6* x 9" black and white photographic prints are available for any photographs or illustrations appearing in this copy for an additional charge. Contact UMI directly to order. ProQuest Information and Learning 300 North Zeeb Road. Ann Arbor, Ml 48106-1346 USA 800-521-0600 Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. THE SOCIAL CONSTRUCT OF THE DOCTOR-PATIENT RELATIONSHIP: ORIGINS AND POTENTIAL FOR CHANGE DISSERTATION Presented in Partial Fulfillment of the Requirements for the Degree Doctor of Philosophy in the Graduate School of The Ohio State University By Maryanna Danis Klatt M.A. ***** The Ohio State University 2002 Dissertation Committee: Approved by Professor Seymour Kleinman, Adviser Professor Lesley Ferris Adviser Professor Thomas Kasulis College of Education Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. UMI Number 3049051 Copyright 2002 by Klatt, Maryanna Danis All rights reserved. UMI UMI Microform 3049051 Copyright 2002 by ProQuest Information and Learning Company. Ail rights reserved. This microform edition is protected against unauthorized copying under Title 17, United States Code. ProQuest Information and Learning Company 300 North Zeeb Road P.O.Box 1346 Ann Arbor, Ml 48106-1346 Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. Copyright by Maryanna Danis Klatt 2002 Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. ABSTRACT This dissertation is an exploration of the ways in which the doctor-patient relationship evolved into a functional social construct that remained fairly constant through most of the 20th century, yet is in a state of transformation at the beginning of the 21st century. This research illuminates factors shaping the relationship, and the elements necessary to build positive doctor-patient relations from the perspective of both doctors and patients. A doctor-patient relationship portrayed in Margaret Edson’s play, WIT, was used as a case study, and as a prompt, for audience members to reflect upon their own doctor-patient relations. Audience members, including doctors, patients, and medical students, were interviewed to explore how they construct their own roles within this relation, in an effort to examine how the construction impacts communication. College students were surveyed to explore younger adults’ conception and expectations of the same relation. Societal reaction to WIT was tracked to gauge the importance of issues raised in the play, as evidenced by the scope of the attention it received. Lastly, an ethnographic experience of teaching a medical school class in which medical students were asked to examine their professional identity construction of “physician” was detailed. ii Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. Patients, doctors, and medical students all considered the social expectations within the doctor-patient relation to be in a state of transformation. Satisfaction with the doctor-patient relation across the board was most clear when the doctor and patient described sharing congruent expectations with the other in this relation. Communication within this relation reflected the perceived role o f the self within the doctor-patient relation. Patients and college students indicated that the most desired approach to treatment by a doctor was “treating them as a whole person.” Cultural influences impacting this relation include openness to various paradigms of wellness and health, a shift toward viewing patients as consumers who are most satisfied with patient-centered care, and acceptance of the Internet as a factor in health information, and potentially, in health communication. A model of communication across cultural difference is explored and recommended as a tool to enhance and facilitate communication within a patient-centered approach to the doctor-patient relation. iii Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. ACKNOWLEDGMENTS This doctoral dissertation came to fruition because of the help and support of many people. Completion of this project was made possible through the friendship and editorial insights of my friend Anne Barnes. The warmth, laughter, and journey traveled together during the past few years were gifts I am fortunate to have experienced. For this, I express deep gratitude. The doctoral research process was enriched by the guidance and encouragement by members of my committee, Seymour Kleinman, Thomas P. Kasulis, and Lesley Ferris. All three members offered me unique steps in this “dance of qualitative research” for which I am most thankful. The research participants that opened their hearts and lives to me through stories of their health care relationships enriched my life and research in a way that convinced me that attainment of a positive health care experience is possible, and is worth seeking and creating. I thank Darcy Lord and Jennifer Strickland for sharing this process that demands community. Most of all, I celebrate my family. My children, Will, Anna, and Joseph Klatt made this project possible by affirming the essential nature of process in each and every goal. For being together in the goal of process, I thank my life-long friend and husband, Bill Klatt, who knows who I am iv Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. VITA June 28, 1960 .................................. Bom - Dayton, Ohio 1982 .................................................B.A. Psychology, Kenyon College 1989 ................................................. M.A. Religious Studies, University of Virginia 2001.................................................M.A. Education, The Ohio State University 1983-1985 ........................................Faculty Member, Bishop Hartley High School 1985-1996 ........................................Faculty Member, Bishop Watterson High School 1996-1997 ........................................Adjunct Faculty Member, Franklin University 1996-1997 ........................................Adjunct Faculty Member, Ohio Dominican College 1999 - 2001 ......................................Graduate Teaching Assistant, The Ohio State University, College of Education FIELDS OF STUDY Major Field: College of Education v Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. TABLE OF CONTENTS Page Abstract .......................................................................................................................ii Acknowledgments ..................................................................................................... iv Vita............................................................................................................................ v List of Tables ..............................................................................................................ix List of Figures ............................................................................................................ x Chapters: 1. Introduction ........................................................................................................1 1.1 The problem ............................................................................................ 1 1.2 Using theater as a means to examine the problem .................................. 3 1.3 The problem plays out: real life consequences ......................................12 1.4 Assumptions and limitations ................................................................. 18 1.5 Expected contributions of the study ...................................................... 19 1.6 Overview of chapters ............................................................................20 2. Framing the doctor-patient relation .................................................................23 2.1 Science and the socially constructed identity of doctor-patient .............23 2.2 Physician as professional ......................................................................34 2.3 Doctor-patient roles within medical discourse and the communicative process .................................................................................................40

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