Communication and Medical Practice: Social Relations in the Clinic

The importance of the doctor-patient interaction in medical practice has become the focus of much recent study and debate. “Patient-centered medicine” has become a new conventional wisdom in medical practice. The power relations involved in doctor-patient interaction have been stressed by recent feminist and critical work in medical sociology. Silverman’s important new volume provides a carefully researched and analytically sensitive view of how doctors and patients in fact relate. Among the key themes of the book are the way in which doctor-patient conversation varies according to the patient’s medical history and method of payment; the problems implicit in pediatric medicine when parents and children are viewed as social actors with psychological propensities; and the difficulties intrinsic to reformist medical practice and patient-centered medicine. This book is essential reading for scholars and students in the fields of medical sociology, medical social work, and professional medical training. “This book confirms David Silverman’s place at the cutting edge of current sociology. It fuses the latest ideas from Europe and the USA with the moral and practical concerns of the British tradition. As a study of medical practice, it will also appeal to reflective practitioners throughout the health professions.” –Robert Dingwall, Centre for Socio-Legal Studies, University of Oxford “This is fascinating sociology. It goes beyond traditional theories–for instance, concerning the significance of social class and language differences in lay-professional encounters–while lucidly exposing more subtle interactional complexities. It develops theory while acknowledging practicalities. Research methods and problems are carefully discussed. This is a clearly organized text with indexes and references.” –Nursing Times “This book has much to offer. Sociologists unfamiliar with the sociolinguistics will find an accessible (i.e., not tediously technical) introduction that shows how discourse analysis can contribute to an understanding of the operation of power. Sociolinguists will appreciate the validation it gives their claim that discourse analysis reveals the substance of social life. Medical sociologists will find sophisticated insights into doctor-patient interaction and professional dominance.” –Contemporary Sociology “I would recommend this book to all those engaged in the practice or study of encounters between patients and health professionals. It is thought provoking, and will fuel many lively debates covering ideology, policy, and clinical practice.” –British Journal of Medical Psychology “David Silverman’s book is perhaps the most substantial and impressive British study yet published in this genre.” –International Journal of Sociology and Social Policy “A particularly refreshing book. . . . A fascinating glimpse of the relationship between professionals in the medical world and their clients. It will strike a particular cord with mental health workers who are a part of perhaps the most intrusive discipline of all.” –Behaviour, Research & Therapy “The analytic style in handling the data makes this work fascinating. . . . In sum, this is a rich work in the sociology of language and communication. . . . This is an important contribution to understanding patient-physician interactions. The emphasis on social forms and deft dismantling of ideological arguments about the nature of medical practice are outstanding contributions.” –Journal of Nervous and Mental Disease

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