Using Normative Rhetorical Theory to Identify Dilemmas and Responses in Internal Medicine Patient-Provider Communication

ABSTRACT

Drawing on normative rhetorical theory (NRT), we examined communication dilemmas that internal medicine residents (IMRs) experience when interacting with patients and responses they adopt to manage these dilemmas. We conducted semi-structured, intensive interviews with 15 IMRs and analyzed the data using the phronetic iterative approach. Findings suggested that IMRs experienced two interpersonal dilemmas: (a) asserting expertise while respecting patients and (b) discussing patient behaviors without indicating deviance. The two dilemmas were more salient for international IMRs who were less familiar with the local culture and embraced a different perspective of the IMR-patient relationship. The two interpersonal dilemmas were connected to a supra-level dilemma of practicing tasks required by evidence-based medicine while being patient-centered. IMRs reported engaging in an interpretive lens to view patients as “people” and communicative responses to manage the dilemmas. By applying NRT to a novel context, our findings demonstrate the impact of macro-level paradigms on IMRs’ conflicting purposes in medical encounters and offer practical implications for communication interventions for IMRs.

Acknowledgments

The authors are grateful to Dr. Charee M. Thompson for her feedback on the early version of the manuscript and two anonymous reviewers for their extremely helpful suggestions.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Funding

The authors disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: The study was completed with the support of Marion Morse Wood Fellowship Fund by the Graduate College at the University of Illinois at Urbana-Champaign granted to the first author for the 2018–2019 academic year.