By Martin Robb; et al
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Extra resources for Communication, relationships and care : a reader
A test is routinely offered to pregnant women and is one of a series of different screening choices that they have to make. The nature of test results, however, involves women in the need to understand quite abstract notions of risk probability and this is something that most women seem to be unprepared for. Pregnant women in the UK are routinely offered an AFP1 screening test for Down’s syndrome between 16 and 20 weeks into their pregnancy. This test measures the amount of alpha feta protein in the blood and this level, at this stage in the pregnancy, combined with an estimate of risk based on the woman’s age, provides a prediction of the probable risk of her baby having Down’s syndrome.
He was desperate to get something done. 2, show points at which the doctor’s replies in the voice of medicine seem very disjointed against the patient’s voicing of his lifeworld concerns. This pattern reoccurs at six points during the consultation, mostly in the ﬁrst half. It is as though the patient tries valiantly to be listened to on his terms but slowly gives up and retreats into the voice of medicine. The doctor uses general interjections such as ‘right’ ‘sure’ and ‘absolutely’. These might be taken as representing a habitual style of communication that is meant to indicate listening and encouraging the patient to talk, and perhaps indicative of good communication skills to the doctor.
As a result medical communication was conducted almost entirely in the voice of medicine and the voice of the lifeworld was suppressed and fragmented. This pattern of communication ﬁts very well with Habermas’ ideas about the system rationalisation and colonisation of the lifeworld. It could be said that doctors are using distorted communication in a success oriented, purposive rational action (albeit unconsciously in all probability). Mishler concludes that for more effective and more humane medical care to be present that doctors would need to employ more balanced forms of communication oriented to achieving greater levels of understanding.