Midwife led consultations in antenatal diabetes care

Midwife led consultations in antenatal diabetes care

by Obianuju Ezidinma Zoe GB-Dumaka -
Number of replies: 3

From the literature I’ve read on discourse analysis, it seems to be the study and scrutiny of language (spoken or unspoken e.g. body language) used in a social setting, in order to better understand a given issue or topic of particular (research) interest. It seeks to identify the meaning behind things, i.e. not what exactly people say but the motive behind what they, the social and cultural dimensions that influence these and how they are in turn interpreted by the other parties involved.

I found an interesting paper1 that described a study in which discourse analysis was used to observe antenatal mid-wife led consultations with diabetic women in Norway. It focussed on the conversations that took place between the diabetic mothers-to-be and the midwife, with each interview being audio taped and transcribed word for word.

From analysis of the paper and the conclusions drawn, it was clear that the different ways in which the midwife and the women communicated gave rise to different degrees of opportunity for the women in question to share their concerns. Depending on what and how it was said by the midwife, the women felt able to or unable to fully voice their concerns, and this could be noticed in the language they in turn used.

In my opinion, this is not only true for the exact case in question, but I feel we can all draw on it.

  • As doctors and other health professionals, the way in which we frame conversations in our consultations will have subtle yet profound effects on their outcome, whether favourable and satisfactory, or not, for all parties involved.
  • When dealing with particularly sensitive issues as this, where we are able to predict anxiety levels in patients, we should construct our speech in such a way as to fulfil our own necessary agenda for the meeting but also be sensitive and empathetic enough to give room for the patient to voice their own concerns. We as professionals need to consider which style of behaviour best suits women and others in equally vulnerable situations.

1 Experts’ encounters in Antenatal Diabetes care: A Descriptive Study of Verbal Communication in Midwife-led consultations - http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3362960/

In reply to Obianuju Ezidinma Zoe GB-Dumaka

Re: Midwife led consultations in antenatal diabetes care

by Deleted user -

I read a similar discourse analysis paper regarding nurses and patients relationships in a community hosptial environment. It seems that the result is the same. When conversations were closely analyzed, certain opportunities made the patient more comfortable in expressing their feelings to the nurse. As you mentioned, it is always important to present the most sincere opportunities for the patient to express their concerns, anxiety, or feelings in general. What do you think is the best way to improve this doctor/patient interaction?

Thanks!

In reply to Deleted user

Re: Midwife led consultations in antenatal diabetes care

by Deleted user -

I agree with you Nicole, many doctors don't allow their patients express their feelings or concerns because the appointment is like a press media interview (who/what, when, where, etc)

In reply to Deleted user

Re: Midwife led consultations in antenatal diabetes care

by Obianuju Ezidinma Zoe GB-Dumaka -

Personally, I think its one of those issues that we all know what the best solution would be "in theory" but in practice is hard to implement, even for the best and most well meaning doctors sometimes. There are times when the pressures of short consultation times and the strict policies and guidelines that have to be met take so much of the doctors' time and energy that it all becomes routine. When this happens, they can fall into the trap of treating patients as mere numbers or 'just another pregnant woman' as in this example, forgetting that for that person, it may be their first time, and therefore a very sensitive or traumatising event. Realising this and consciously learning to empathise with ALL patients I think is the best way forward.

 

I thin in the case of consultations like this where dealing with vulnerale patients, special time should be set aside to deal with their own issues and not just the doctors agenda, and if that means extending conultation times then so be it. However how far do you go with this? Its a tricky one but I think the best way forward is just training doctors the whole way through their careers on the importance of communication and maybe regular feedback on their own consultations and the impact they have on their patients in order for them to self appraise and improve.