The rhetoric of patient voice: Reported talk with patients in referral and consultation letters

Authors

  • Marlee M. Spafford School of Optometry, University of Waterloo, Ontario, Canada
  • Catherine F. Schryer Department of English, Language & Literature, University of Waterloo, Ontario, Canada
  • Lorelei Lingard The Learning Institute, Hospital for Sick Children, Ontario, Canada

DOI:

https://doi.org/10.1558/cam.v5i2.183

Keywords:

reported speech, patient voice, referral letters, consultation letters, optometry, ophthalmology

Abstract

Referral and consultation letters are written to enable the exchange of patient information and facilitate the trajectory of patients through the healthcare system. Yet, these letters, written about yet apart from patients, also sustain and constrain professional relationships and influence attitudes towards patients. We analysed 35 optometry referral letters and 35 corresponding ophthalmology consultation letters for reported ‘patient voice’ coded as ‘experience’ or ‘agenda’ and we interviewed 15 letter writers (eight optometry students, six optometrists, and one community ophthalmologist). There were 80 instances of reported ‘patient voice’ in 35 letters. The majority (68%) of the instances occurred in referral letters, likely due to differences in both ‘letter function’ and ‘professional stance’. Reported ‘patient voice’ occurred predominantly as ‘experience’ (81%) rather than ‘agenda’ instances. Letters writers focused on their readers’ needs, thus a biomedical voice dominated the letters and instances of reported ‘patient voice’ were recontextualized for the professional audience. While reporting ‘patient voice’ was not the norm in these letters, its inclusion appeared to accomplish specific work: to persuade reader action, to question patient credibility, and to highlight patient agency. These letter strategies reflect professional attitudes about patients and their care.

Author Biographies

Marlee M. Spafford, School of Optometry, University of Waterloo, Ontario, Canada

Marlee M. Spafford received her PhD in Theory and Policy Studies in Education from the Ontario Institute for Studies in Education/University of Toronto. She is an optometrist and an associate professor at the University of Waterloo’s School of Optometry. Her research programme investigates aspects of healthcare education, communication, socialization, and equity.

Catherine F. Schryer, Department of English, Language & Literature, University of Waterloo, Ontario, Canada

Catherine F. Schryer received her PhD in Rhetoric and Composition Studies from the University of Louisville. She is a rhetorician and an associate professor at the University of Waterloo’s Department of English, Language and Literature and the Director of the Centre for Teaching Excellence at the University of Waterloo. Her research interests involve investigating genres or text types in specific social contexts, combing textual analysis with qualitative data-gathering techniques.

Lorelei Lingard, The Learning Institute, Hospital for Sick Children, Ontario, Canada

Lorelei Lingard received her PhD in English/Rhetoric from Simon Fraser University. She is a rhetorician and a senior educational researcher at The Learning Institute, Hospital for Sick Children. She is also an associate professor in the Departments of Pediatrics and Health Policy, Management, and Evaluation, and an educational scientist in the University of Toronto’s Wilson Centre for Research in Education. Her research programme explores team communication patterns as they impact on novice socialization and patient safety.

Published

2009-03-14

How to Cite

Spafford, M. M., Schryer, C. F., & Lingard, L. (2009). The rhetoric of patient voice: Reported talk with patients in referral and consultation letters. Communication and Medicine, 5(2), 183–194. https://doi.org/10.1558/cam.v5i2.183

Issue

Section

Articles