The Story of Medicine: from Paternalism To
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THE STORY OF MEDICINE: FROM PATERNALISM TO PARTNERSHIP Jennifer Lynn Marks Submitted to the faculty of the University Graduate School in partial fulfillment of the requirements for the degree Master of Arts in the Department of Communication Studies, Indiana University August 2012 Accepted by the Faculty of Indiana University, in partial fulfillment of the requirements for the degree of Master of Arts. ___________________________________ Kristina Horn Sheeler, Ph.D., Chair ___________________________________ John Parrish-Sprowl, Ph.D. Master’s Thesis Committee ___________________________________ Kristine Brunovska Karnick, Ph.D. ii ACKNOWLEDGEMENTS First of all, to the wonderfully kind physicians who took time out of their extremely busy schedules to share their stories with me—I want to express my deepest thanks and appreciation. It has been a privilege to speak with each of you, and I am proud to carry your collective voice to others. I would like to thank Kristy Sheeler, my advisor throughout undergraduate and graduate school, for giving me the rhetorical foundation on which I have built my scholastic career. You introduced me to Bitzer and Fisher, whose work became my academic lenses as I made sense of my small place in the world. I also thank you for gently pulling me back when my ideas have been larger than the task at hand. I would like to thank John Parrish-Sprowl for giving me innovative ways to think about things—even those that seem most routine. You exude knowledge during every conversation and help everyone to be cognizant of the fact that learning is a lifelong process. Additionally, I would like to thank Kristine Karnick for always believing that my ideas are interesting and that I have important things to say. That has meant the world to me, especially as a graduate student. I want to give special thanks to my very best friend in the entire world for being my rock in life and always letting me lean on you. I realize I have leaned especially hard throughout my thesis preparation, but your strength and guidance have never faltered. Please know that I could not clear my largest hurdles without your encouragement. When I doubt myself, you restore my faith with your unwavering support and belief in iii me. You understand me like no one else does and help me feel less alone in the world. I will love and appreciate you forever. To my home and work families, I would also like to express my heartfelt love and appreciation for believing in me and accommodating my schedule through the years so that I could achieve my goals. I could not have done this without any of you, and I deeply thank you. iv ABSTRACT Jennifer Lynn Marks THE STORY OF MEDICINE: FROM PATERNALISM TO PARTNERSHIP Physicians were interviewed and asked about their perspectives on communicating with patients, media, and the ways in which the biomedical and biopsychosocial models function in the practice of medicine. Fisher’s Narrative Paradigm was the primary critical method applied to themes that emerged from the interviews. Those emergent themes included the importance of a team approach to patient care; perspectives on physicians as bad communicators; and successful communication strategies when talking to patients. Physicians rely on nurses and other support staff, but the most important partnership is that between the physician and patient. Narrative fidelity and probability are satisfied by strategies physicians use in communicating with patients: using understandable language when talking to patients; engaging in nonverbal tactics of sitting down with patients, making eye contact with patients, and making appropriate physical contact with them in the form of a handshake or a light touch on the arm. Physicians are frustrated by media’s reporting of preliminary study results that omit details as well as media’s fostering of expectations for quick diagnostic processes and magical cures within the public. Furthermore, physicians see the biomedical and biopsychosocial models becoming increasingly interdependent in the practice of medicine, which carries the story of contemporary medicine further into the realm of partnership, revealing its humanity as well as its fading paternalism. Kristina Horn Sheeler, Ph.D., Chair v TABLE OF CONTENTS Abbreviations & Definitions............................................................................................ viii Introduction..........................................................................................................................1 Rationale ..............................................................................................................................5 Literature Review ................................................................................................................9 Methodology......................................................................................................................16 Analysis Teamwork ..............................................................................................................20 Physician-Patient Partnership ................................................................................25 Return to the Theme of Teamwork at Large..........................................................35 Physician-Patient Communication.........................................................................39 Physicians’ Perspectives on Biomedicine..............................................................54 Physicians’ Perspectives on Media........................................................................66 Conversational/Story Elements..............................................................................77 Future Research .................................................................................................................82 Conclusions........................................................................................................................84 Limitations.........................................................................................................................85 Appendices Appendix A............................................................................................................86 Appendix B..........................................................................................................102 Appendix C..........................................................................................................113 Appendix D..........................................................................................................123 Appendix E ..........................................................................................................141 vi Appendix F ..........................................................................................................154 Appendix G..........................................................................................................172 Appendix H..........................................................................................................182 Appendix I ...........................................................................................................193 Appendix J ...........................................................................................................216 Appendix K..........................................................................................................233 Appendix L ..........................................................................................................256 References........................................................................................................................277 Curriculum Vitae vii ABBREVIATIONS & DEFINITIONS Angina: Chest pain. Angioplasty: Involves temporarily inserting and blowing up a tiny balloon where an artery is clogged to help widen the artery (Mayo Clinic). Cardiologist: Physician who specializes in treating the heart/cardiovascular system. Cellulitis: “Common, potentially serious bacterial skin infection. Cellulitis appears as a swollen, red area of skin that feels hot and tender, and it may spread rapidly” (Mayo Clinic). Defibrillator: Device used to shock the heart back into a normal rhythm [may be internal, i.e., implantable cardioverter device (ICD) or external, i.e., shock paddles]. Ejection Fraction (EF): “A measurement of how well your heart is pumping” (May Clinic). Electrophysiologist: Cardiologist with special training in treating heart rhythm disturbances. Familial Hypercholesterolemia: Extremely high total cholesterol level that is hereditary in nature. Hyperlipidemia: High level of fats in the blood. Hypertriglyceridemia: A high level of triglycerides, or specific type of fat, in the blood. Hypertriglyceridemia is a type of hyperlipidemia. Low-Density Lipoprotein (LDL): “Bad” cholesterol. Myocardial Infarction (MI): A.K.A., Heart attack—“Occurs when a blood clot blocks the flow of blood through a coronary artery — a blood vessel that feeds blood to a part of the heart muscle.” (Mayo Clinic) Nephrologist: Physician who specializes in treating the kidneys. NPO: Literally, “nothing per oral”- when patients cannot eat or drink anything prior to a test or procedure, they are considered to be of ‘NPO’ status. Patent Foramen Ovale (PFO): “While a baby grows in the womb, there is a normal opening between the left and right atria (upper chambers) of the heart. If this opening fails to close naturally soon after the baby is born, the hole is called patent foramen ovale (PFO).” (U.S. National