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Health research suggests that personal agency plays a key role in health experiences. In this qualitative analysis of the experiences of 40 recent mothers accessing healthcare services from physicians and midwives, we found that agency is linked to democratic relationships that support women's access to and discussion of relevant health information. While most participants wanted to participate more actively in their care, problematic physician-patient communication hampered their ability to exercise personal agency. This was not true for midwives who have a model of practice that emphasizes education and choice. Different understandings of embodiment affect the development of health care relationships.
KEY WORDS: Pregnancy, midwives, personal agency, social determinants of health, physician-patient communication, qualitative health research, health care relationships.
Ainsworth-Vaughn, N. (1994). Is that a rhetorical question? Ambiguity and power in medical discourse. Journal of Linguistic Anthropology, 4(2), 194-214.
Barry, C.A., Stevenson, P.A., Britten, N., Barber, N. & Bradley, C.P. (2001). Giving voice to the lifeworld. More humane, more effective medical care? A qualitative study of doctor-patient communication in general practice. Social Science & Medicine, 53, 487-505.
Beisecker, A.E. (1990). Patient power in doctor-patient communication: What do we know? Health Communication, 2, 105-122.
Benner, P. (1985). Quality of life: A phenomenological perspective on explanation, prediction and understanding in nursing science. Advances in Nursing Science, 8(1), 1-14.
Brody, H. (1987). Stories of Sickness. New Haven: Yale.
Brundtland, G.H. (2000). The World Health Report 2000: Health systems-Improving performance. Geneva, Switzerland: World Health Organization.
Brunt, H., Chappell, N.L., McClure, M., & Cassells, A. (1998). Assessing the effectiveness of government and industry media campaigns on seniors' perceptions of Reference Based Pricing Policy. Journal of Applied Gerontology, 17(3), 276-295.
Cassell, E. (1985). Talking with Patients. Volume 1: The Theory of Doctor-Patient Communication. Cambridge, MA: MIT Press.
Charon, R. (1986). To render the lives of patients. Literature and Medicine, 5, 58-74.
Charon, R. (1989). Doctor-patient/reader-writer: Learning to find the text. Soundings, 72, 1101-1116.
Clarke, P., & Evans, S.H. (1998). Surviving modern medicine: How to get the best from doctors, family and friends. New Brunswick, N.J.: Rutgers University Press.
Clarke, J.A. & Mischler, E.G. (1992). Attending to patients' stories: Refraining the task. Sociology of Health and Illness, 14(3), 344-372.
Clowers, M. (2002). Young women describe the ideal physician. Adolescence, 37, 695-704.
Coulter, A. (2002). Patients' views of the good doctor. British Medical Journal, 325, 668-669.
Davis, K. (1988). Power Under the Microscope: Towards a Grounded Theory of Gender Relations in Medical Encounters. Dordrecht, NL: Foris.
DiMatteo, M.R. (1994). The physician-patient relationship: Effects on the quality of healthcare. Clinical Obstetrics and Gynaecology, 37(1), 149-161.
Evans, R. (1984). Strained mercy: The economics of Canadian healthcare. Toronto: Butterworths.
Feeney, D., Guyatt, G. & Tugwell, P. (1986). Healthcare technology: Effectiveness, efficiency and public policy. Montreal: The Institute for Research on Public Policy.
Fisher, S., & Groce, S.B. (1985). Doctor-patient negotiation of cultural assumptions. Sociology of Health and Illness, 7, 72-85.
Fisher, S., & Groce, S.B. (1990). Accounting practices in medical interviews. Language in Society, 19, 225-250.
Frankel, R. & Beckman, H. (1989). Evaluating the patient's primary problem(s). In M. Stewart & D. Roter (eds.), Communicating with medical patients (pp. 86-98) Newbury Park, California: Sage Publications.
Giorgi, A. (1975). An application of phenomenological method in psychology. In A. Giorgi, C. Fischer, & E. Murray (Eds.), Duquesne studies in phenomenological psychology, II (pp. 82-103). Pittsburgh, PA: Duquesne University Press.
Giorgi, A, (1994). A phenomenological perspective of certain qualitative research methods. Journal of Phenomenological Psychology, 26, 190-220.
Gordon, R. (1996). Manifesto for a new medicine. New York: Addison-Wesley.
Greenfield, S., Kaplan, S., & Ware, J.E. (1985). Expanding patient involvement in care: Effects on patient outcomes. Annals of Internal Medicine, 102, 520-528.
Harrington, A. (1999). The Placebo Effect: An Interdisciplinary Exploration. Cambridge, MA: Harvard University Press.
Helman, C. (1990). Culture, Health and Illness: An Introduction to Health Professionals. Bristol: Wright.
Koenig, H.G. (1999). The Healing Power of Faith. New York: Simon & Schuster.
Kreps, G.L., O'Hare, D., & Glowers, M. (1994). The influences of human communication on health outcomes. American Behavioral Scientist, 38(2), 248-256.
Kvale, S. (1996). Interviews: An Introduction to Qualitative Research Interviewing. London: Sage.
Leder, D. (Ed.). (1992). The body in medical thought and practice. Philosophy and Medicine, Volume 43. London: Kluwer Academic Publishers.
Leiderman, D., & Grisso, J. (1985). The Gomer Phenomenon. Journal of Health and Social Behaviour, 26, 222-231.
Maeside, P. (1991). Possibly abusive, often benign, and always necessary: On power and domination in medical practice. Sociology of Health and Illness, 13, 545-561.
Marvel, M.K., Epstein, R.M., Flowers, K. & Beckman, H.B. (1999). Soliciting the patient's agenda. Have we improved? Journal of the American Medical Association, 281, 283-287.
McNiven, P., Hodnett, E., & O'Brien-Pallas, L.L. (1992). Supporting women in labour: A work sampling study of the activities of labour and delivery nurses, Birth, 19(1), 3-9.
Mead, G.H. (1977). On Social Psychology. Chicago: The University of Chicago Press.
Mintz, D. (1992). What's in a word: The distancing function of language in medicine. Journal of Medical Humanities, 13(4), 223-233.
Mishler, E. (1985). The Discourse of Medicine. New York: Ablex.
Morrow, D. (1997). Improving consultations between health-care professionals and older clients: Implications for pharmacists. International Journal of Aging and Human Development, 44(1), 47-72.
Mullett, J., & Coughlan, R. (1998). Clinician and seniors' views of Reference Based Pricing: Two sides of a coin. Journal of Applied Gerontology, 17(3), 296-317.
Omery, A. (1983). Phenomenology: A method for nursing research. Advances in Nursing Science, 5, 49-63.
Pendleton, D., & Bochner, S. (1980). The communication of medical information in general practice consultations as a function of social class. Social Science and Medicine, 14A, 669-673.
Phillips, D. (1996). Medical professional dominance and client dissatisfaction: A study of doctor-patient interaction and reported dissatisfaction with medical care among female patients at four hospitals in Trinidad and Tobago. Social Science & Medicine, 42, 1419-25.
Pinder, R. (1990). The management of chronic disease: Patient and doctor perspectives on Parkinson's disease. London: MacMillan Press.
Rosenthal, S.B., & Bourgeois, P.L. (1991). Mead and Merleau-Ponty: Towards a Common Vision. New York: State University of New York Press.
Roter, D., & Hall, J.A. (1998). Why physician gender matters in shaping the physician-patient relationship. Journal of Women's Health, 7, 1093-97.
Roter, D., Hall, J.A., Merisca, R. & Nordstrom, B. (1998). Effectiveness of interventions to improve patient compliance: A meta-analysis. Medical Care, 36, 1138-61.
Roter, D., Lipkin, M., & Korsgaard, S. (1991). Sex differences in patients' and physicians' communication during primary care medical visits. Medical Care, 29, 1083-1093.
Schutz, A. (1962). Collected papers I: The problem of social reality. Boston: Martinus Nijhoff.
Scully, D. (1980). Men who control women's health: The mis-education of obstetrician-gynecologists. Boston: Houghton-Miflin.
Spiegelberg, H. (1975). Doing Phenomenology. The Hague: Nijhoff.
Statistics Canada. (1995). National population health survey. Ottawa.
Stephenson, P., & Holmes, C. (2000). The Elders Listening Project: Elder Friendly Hospital Initiative of the Capital Health Region. Victoria, B.C. Capital Health Region/ University of Victoria.
Stewart, M., Brown, J.B., Weston, W.W., & McWhinney. (1999). Patient-centered Medicine: Transforming the Clinical Method. Newbury Park, CA. Sage.
Stewart, M., & Roter, D. (1989). Communication with Medical Patients. Newbury Park, CA: Sage.
Street, R. (1992). Communicative styles and adaptations in physician-patient consultations. Social Science and Medicine, 34(10), 1155-63.
Street, R. (2001). Active patients as powerful communicators. In W. P. Robinson & H. Giles (Eds.), The New Handbook of Language and Social Psychology, (pp. 541-60). Chichester, U.K.: Wiley & Sons.
Tarlov, A. (1992). The coming influence of a social sciences perspective on medical education. Academic Medicine, 67, 724-731.
Tarlov, A. (2000). Society and population health. New York: The New Press.
Taylor, S.J., & Bogdan, R. (1984). Introduction to Qualitative Research: The Search for Meanings. New York: John Wiley.
Ten-Have, P. (1987). Medicine and the Cartesian image of man. Theory and Medicine, 8(2), 235-246.
Townson, M. (1999). Health and Wealth: How Social and Economic Factors Affect our Well-Being. Toronto: Canadian Centre for Policy Alternatives.
Vygotsky, L.S. (1978). Mind in Society. Cambridge, Mass: Harvard University Press.
Waitzkin, H. (1985). Information giving in medical care. Journal of Health and Social Behaviour, 26, 129-146.
Waitzkin, H. (1995). Doctor-patient communication: Clinical implications of social science research. JAMA, 252(17), 2441-2446.
Weijts, W. (1994). Responsible health communication: Talcing control of our lives. American Behavioral Scientist, 38(2), 257-67.
Weijts, W., Widdershowen, G., Kok, G., & Tomlow, P. (1993). Patients' informationseeking actions and physicians' responses in gynecological consultations. Qualitative Health Research, 3, 398-121.
Winefield, H.R., & Murrell, T.G. (1991). Speech patterns and satisfaction hi diagnostic and prescriptive stages of general practice consultations. British Journal of Medical Psychology, 64, 103-115.
Rory Coughlan, Department of Psychology, Trent University,
Karen E. Jung, University of Victoria, British Columbia, Canada
Acknowledgements: The research on which this article is based received generous support in the form of a SSHRC Fellowship and a Dr. Julius Schleicher Fellowship for Research in Medicine.
All correspondence to be sent to: Dr. Rory Coughlan, Assistant Professor of Health Psychology, Department of Psychology, Trent University, 1600 West Bank Drive, Peterborough, ON, K9J 7B8, Canada. Phone: 1-705-748-1011 ext. 1079. Fax: 1-705-7481580. Email: firstname.lastname@example.org
Karen E. Jung, Department of Sociology, University of Victoria, Mailing Address: 450 Weller Street, Peterborough, ON, K9H 2N6, Canada. Phone: 1-705-745-6526. Email: email@example.com