Writing wrongs? An analysis of published discourses about the use of patient information leaflets
Introduction
As Lupton (1992) has pointed out, publications about communication with patients warrant more critical interest than they are usually accorded. This paper takes as its topic of interest the large number of publications about the use of information leaflets for patients. It will be argued that a number of discourses about the use of patient information leaflets can be distinguished in these publications. I will examine two discourses in detail, and, using Potter and Wetherell's (1994) approach, will attempt to identify the resources that these discourses draw on. The first discourse, it will be argued, characterises patients as incompetent and passive, invokes a mechanistic model of communication, and derives its interest in printed information from a concern with how communication might affect outcomes defined as biomedically important. The second discourse is much more recent and smaller in volume. This discourse derives much of its motivation for exploring the use of printed information from its interest in the role of information materials in “empowering” patients.
The paper will suggest that the different types of resources drawn on by the two discourses reflect different orientations towards, and conceptualisations of, patients. In its analysis of these resources, the paper will have as a secondary aim a contribution to an ongoing debate about the persistence of the biomedical model as a dominant discursive resource in writings about patients. The biomedical model is one which is reductionist in form, privileging biological explanations of disease over social, cultural, and biographical explanations, and which sees patients as passive organisms to whom doctors “do” things (Nettleton, 1995). Armstrong's (1983), Armstrong's (1984) analysis pointed to the disappearance of this tendency to reduce patients to organisms, and suggested that published medical discourses — in medical textbooks, medical journals and so on — have gradually come to share a common perspective with the social sciences on what he calls “the patient's view”. In practice, this means that the medical “gaze” has been extended to include an increased emphasis on the patient's social context and experiences rather than solely relying on signs, symptoms, and demonstrable pathologies. More recently, it has been argued (Kelly & Field, 1994; Ogden, 1996) that the opposition between a biomedical model and a social model of medicine has been overdrawn. Kelly and Field (1994, p. 35) propose that “few practitioners, and no textbooks of any repute” subscribe to uni-directional causal models, and that medicine tends to be more holistic than medical sociology traditionally has credited. This has led to a reassessment of the traditional sociological view (e.g. Mishler et al., 1981) that the biomedical model continues to dominate medical practices and discourses. However, others (Williams, 1996; Samson, 1995) find evidence of the domination of a largely reductionist, disease-oriented model of medicine, which may even have seen in recent years a further intensification of biomedically focused physical treatments and aetiological theories. An analysis of the ways in which patients are talked about in publications about the use of patient information leaflets could do much to move this debate on, by allowing empirical exploration of the extent to which a biomedical model, with its associated sociologically limited view of patients, appears to persist.
Section snippets
Methods
The “data” of this paper are the texts of articles, books, and other publications about the use of printed information for patients. In analysing these data, this paper will draw on the increasingly influential approach of Potter and Wetherell (1987), who propose that texts should be examined as social practices, and that analysis should seek to explore how accounts are constructed and the functions they perform. A key objective of this kind of analysis is to identify and describe the
Results
During the analysis, it became clear that both the issues deemed important and the ways in which they were discussed differed systematically between what eventually came to be seen as two groups of texts, and these were therefore distinguished as two different discourses. I labelled these as follows:
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the “patient education” discourse,
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the “patient empowerment” discourse
The “patient education” discourse has been, in terms of volume of papers published, by far the more dominant. As will be argued
Discussion
This paper has attempted to analyse published discourses about the use of printed information for patients. Clearly, other accounts of the texts of the publications that were analysed might be possible (Parker & Burman, 1993), but the validity of the analysis presented here rests on its plausibility as an interpretive account of the data and is warranted by its attention to the detail of the texts (Gill, 1996). The approach would appear to be a successful way of identifying and characterising
Acknowledgements
I am indebted to Professor Ray Fitzpatrick for his advice and comments on earlier drafts of this paper. I am also grateful for the comments of three anonymous referees on an earlier draft.
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