The move to patient-centered medical practice is important for providing relevant and sustainable health care. Narrative medicine, for example, suggests that patients should be involved significantly in diagnosis and treatment. In order to understand the meaning of symptoms and interventions, therefore, physicians must enter the life worlds of patients. But physicians face high patient loads and limited time for extended consultations. In current medical practice, then, is narrative medicine possible? We argue that engaging patient perspectives in the medical visit does (...) not necessarily require a lengthy interview. Instead, a new orientation to this process that emphasizes dialogue between practitioners and patients should be considered. In this new model, the purpose of the visit is to communicate successfully and develop a mutual understanding of illness and care. (shrink)

Despite an expansive literature on communication in medicine, the role of language is dealt with mostly indirectly. Recently, narrative medicine has emerged as a strategy to improve doctor-patient communication and integrate patient perspectives. However, even in this field which is predicated on language use, scholars have not specifically reflected on how language functions in medicine. In this theoretical paper, the authors consider how different models of language use, which have been proposed in the philosophical literature, might be applied to communication (...) in medicine. In particular, the authors contrast the traditional, indexical thesis of language with new models that focus on interpretation instead of standardization. The authors demonstrate how paying close attention to the role of language in medicine provides a philosophical foundation for supporting recent changes in doctor-patient communication. In particular, interpretive models are at the foundation of new approaches such as narrative medicine, that emphasize listening to patient stories, rather than merely collecting information. Ultimately, debates regarding the role of language which have largely resided in non-medical literatures, have important implications for describing communication in medicine. In particular, interpretive models of language use provide an important rationale for facilitating a more robust dialogue between doctors and patients. (shrink)

Although scholars have thoroughly assessed American Evangelical Protestants’ beliefs about government intervention in addressing socioeconomic stratification and racial discrimination, they have paid considerably less attention to interpretations of health care reform. Especially important is that American Evangelicalism in recent years has incorporated personal accountability in such a way that makes this group distinctive when considering social responsibility toward others. Whereas earlier Evangelicals were instrumental in furthering the social gospel, American Evangelicals today prioritize matters of personal accountability ahead of social action. (...) The cultural toolkit available to Evangelicals includes a rationale for caring for others, but an emphasis on personal accountability shapes how they evaluate government health care interventions. This paper employs qualitative methods to understand how Evangelicals link such individualism with strategies for caring for others in the context of health care. The findings suggest that Evangelicals emphasize personal accountability, especially when evaluating government programs. However, personal accountability is accompanied by a conflicting ethical responsibility to provide care to others. The priority given to personal accountability or an ethic of care, however, varies according to the situational context or social location of white Evangelicals. These findings may be helpful in framing future health policies to draw Evangelical support. (shrink)

Social planners have begun to recognize that communities are an important resource for solving many problems. Understanding local norms and values is thought to provide insight into how issues are defined and what interventions might be considered practical. Communities in this framework are not just the physical locations at which programs are targeted, but are actively constructed spaces that must be properly understood. In many ways, the field of public health has been sensitive to this understanding and has elevated the (...) community in importance, thus emphasizing that significant features are variable and locally defined. Even in the new public health, however, empirical indicators are still often relied on, thereby leading to the increasing standardization of communities, rather than to openness to neighborhood particularities. For this reason, a community-based focus should guide future public health endeavors. Most important, this strategy underscores the importance of getting to know the communities in which symptoms, illness and care are defined, and allows for full participation by community members that make interventions both relevant and sustainable. (shrink)