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Doctor and patient in conversation

Dr Kayo Kondo from our School of Modern Languages and Cultures focuses her research on patient-/person-centred care and communication in health and social care settings. Her interests include the interactions between patients and professionals and clinical empathy. Dr Kondo recently wrote a book about patient-centred communication, and in this article, she explains how face and politeness theory interact with patient-centred communication.

The notion of ‘face’ is central to patient-centred communication. It is very important for healthcare professionals to be able to elicit a patient’s thoughts and concerns and to understand their specific experience of symptoms. Patients have their own ‘life-worlds’, and doctors have their own professional frame of mind. Teasing out clues as to the onset and ongoing manifestation of illness requires trust and rapport; otherwise, the patient would probably swallow their words.

In daily communication, the concept of ‘face’ arises in expressions such as ‘losing face’ (losing the respect of others) or ‘saving face’ (preventing someone from feeling embarrassed). According to Canadian-born sociologist Erving Goffman, ‘face’ as an interactional identity is an East Asian-originated concept introduced by Chinese anthropologist Hu Hsien Chin in 1944. Face has multiple sides, each of which is an ‘image’ the person projects, and it is mutual work. Its role in interactions can be observed in much of Goffman’s study of ‘face-work’. In a similar vein, Japanese philosopher Shinzo Mori powerfully stated: ‘Our whole life is a kind of “face-making” of who we are, so to speak. We spend our whole life finishing the only “face” we have.’

The patient-doctor relationship may be subject to the image that the professional projects and that the patient perceives, and vice versa. Attentive listening can meet the patient’s needs and can avoid the potential for emotional harm to the patient. When the patient feels that the doctor is interested in them as a person and trusts the relationship, the relationship can become a partnership. It can be fair to say that patient-centred communication is well intentioned and materialises when mutual face-needs are supported or when an actual ‘face-threat’ is avoided.

The doctors in this book discuss their ‘inner-self’ as a professional and person. I interviewed them about how and why their communication style with patients has changed. They may try to protect the patient’s face (prevent them from feeling embarrassed), enhance the patient’s face (by acknowledging and accepting), or preserve the patient’s face (by respecting their privacy and preserving the patient’s wish to be independent). The older patients in this book displayed their ‘patient’s face’ in their desire to live independently and demonstrate competence in their daily life through activities such as making meals, gardening, and decision-making. There is a thread that connects the health professional’s and the patient’s respective ‘desires’. Carefully identifying the patient’s face-needs links with acts that seek to establish how much they want to be involved in discussion and decision-making regarding care.

This study is based on fieldwork and concerns face and politeness issues in authentic medical consultations with older patients in Tokyo, and draws attention to cultural variations in Western theories of patient-centred communication. I hope that this book can facilitate communication training for all health professionals and students and increase awareness of the issues of face and politeness in a way that will enhance the experiences of older adults receiving health care and social services.

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