Catherine C. Gouge
Associate Professor of English/PhD
West Virginia University
I am currently exploring material feminist and post-humanist approaches to healthcare communication and medical rhetoric. This work seeks to articulate productive alternatives to humanist frameworks for thinking about specific communication practices and related cultural contexts.
My most recent project is about improving patient discharge communication. Because a provision in the Patient Protection and Affordable Care Act (2010) will this year begin penalizing hospitals with excessive patient readmission rates and because many have cited improving discharge communication with patients as a critical component of reducing avoidable readmissions, my project takes up the question of how to improve patient discharge communication practices. In a review of the literature about discharge communication practices with patients, I noticed a tendency to consider patient adherence a measure of effective communication. I speculate that perhaps the humanist, patient-centered care movement’s emphasis on the patient, though designed to be a corrective to a culture of compliance in biomedicine, has inadvertently reinforced the terms of the debate and limited efforts to improve patient discharge communication practices. To redress this, I propose an approach to studying patient discharge communication that accounts for the multivariate contingency of knowledge in the discharge process and does not place the patient at the center of study. Such an approach, I argue, will make it possible to identify potential innovation in patient communication that we might not otherwise see if our attention is fixed on patient compliance or adherence as it has been—innovation and improvisation that likely already exists unofficially in systems of care but go unrecognized and, as a result, unincorporated into practice. My project proposes that technical communicators can help support such a shift by engaging posthumanist (not anti-humanist) methods for studying patient communication practices—methods that would facilitate the study of the networks of which patient discharge instructions are a part. I discuss specific sets of patient discharge instructions, review studies of discharge communication, and as a critical context for this study, consider the patient-centered care movement and its relationship to a culture of compliance in biomedicine.
Though I plan to continue to this work about discharge communication practices with site observations and mapping projects, my next two projects will explore a posthumanist, material feminist approach 1) to rethinking deviance in medicine (a presentation for Feminisms and Rhetoric this fall) and 2) to considering the ways that bodily monitoring technologies structure us as medical subjects and objects (for the Association for the Rhetoric of Science and Technology NCA pre-conference, also this fall).
key words to describe work
Patient communication, patient documentation, systems of care, technologies of care, compliance rhetoric, posthumanism, material feminism
Work in relation to symposium keywords
Connections and theory relate most to my work.
These two key words resonate most with me because I am interested in posthumanist theory and the ways that posthumanist approaches to the study of medical rhetoric and communication practices can help us think differently about patient communication and compliance issues in productive ways. According to such an approach, it is necessary to consider the relationships among both human and nonhuman actors in networks and to explore the ways that such relationships facilitate, complicate, and intervene in communication processes.
- How do you explain/define what you do to medical personnel and/or other stakeholders in the research process or to the public?
When discussing my current work, I usually start by introducing the local, practical value of my work to specific stakeholder interests as I see it and then, if the interest seems to be there, to situate that in the context of related questions and/or a critique of broader issues. For example, with nurses and physicians or even others in my home English Department who are unfamiliar with the field, I talk about the ways that technical communicators can help improve transitional care communication practices and what that might look like in practice. I explain that such work might include observing and mapping communication practices in a unit, department, or other setting; noting relationships among actors, points of conflict and negotiaton, and/or existing innovation; considering ways that innovation used or workarounds found in one area or department of the network might be used to improve communication practices in another; and thinking about the opportunities for training staff and revising documents and protocol.
- What other keywords would you add to the list above (connections, dissemination, ethics, methods, and theory) and why? (no more than three additions)
Systems—because I see more and more mention of “systems of care” in texts written by critical medical studies people to refer to the current practices of health care and treatment processes (but I like “connections” as a way of getting at this, too).
Value—because this word or the concept it references is often present in our discussions with each other and others (both—at least—in terms of what counts as valuable research among those studying medical rhetoric or health communication and what is valued in health care by different stakeholders), but it seems less often discussed explicitly.