Patient agency: connecting the dots in my research
As I transition from full-time academia to my own adventures in business, it’s given me pause to reflect on the story of my research. I have always tried to pursue research projects that I have felt would be important, impactful, or interesting. Preferably all three.
I started researching communication in healthcare due to personal interest. As a young person with what had become chronic pain, I had experienced what might be called “bad” communication. These experiences occurred at the same time as when I studying linguistics in my undergraduate degree. I’d fallen in love with a course I took on Conversation Analysis — it was so fascinating and opened up a whole way of looking at the world.
Instead of assuming doctors are bad communicators, I wanted to understand how doctors and patients get things done through conversation. Starting with surgeons, I began by examining how consultations happened — how did surgeons and patients get from the first greeting to the end of the conversation.
This led to an exploration of patient agency and, in reflecting on the story of my research, I realise this is a thread that has continued through my research as well as my teaching and advocacy. It has been important to me to describe how patients are not passive recipients in healthcare. How they contribute to the consultation in ways that are active yet with consideration of the expected socio-cultural norms of communication when seeing the doctor.
Agency has remained a core component of my research even as I’ve researched other clinical professions and had different focal topics. In researching telehealth for specialists and surgeons and then for general practitioners, we found ways in which patients manage to initiate additional contributions to the consultation and how conversational (rather than transactional) approaches by GPs can facilitate additional patient contributions.
Patients can exert agency and clinicians can be proactive in supporting agency within the consultation through their conversational choices.
This has extended to my research on teaching communication in healthcare. We have demonstrated how in simulated interactions actors-as-patients do not communicate in the same way that actual patients do and that sometimes clinicians need individualised feedback to identify the ways in which they may inadvertently be hindering patient agency.
Consideration of how patient agency is collaboratively achieved has informed my teaching, with inclusion of conversation analytic conceptualisations of agency into communication curricula. In reflecting on current approaches to teaching and assessing healthcare communication, I have also identified the potential harms to patient agency to which such simplified approaches may contribute.
Agency has also constituted a key component in position papers and opinion pieces, including an Australia and Aotearoa New Zealand collaborative conversation starter in which we argue for tailored communication that supports active patient participation. And I argue that the responsibility for supporting patient agency rests with the clinician.
When I tell people what I research and teach, I am often confronted with stories of when consultations have not been a positive or productive experience. This can stymie patient attempts to exert agency. These stories motivate me to continue public-facing communication through social media and industry publications.
“patients have interactional means through which they can assume agency”
As I continue on my journey in supporting clinicians, students, and organisations to improve communication, patient agency and how it is achieved and how it can be better centred in consultations, will remain central to my work.