Too Passive or Overly Involved? Healthcare Professionals' Narratives on Challenging Interactional Situations with Their Clients

Doctor

Healthcare professionals encounter challenging interactional situations in their client work. These challenges may stem from various factors, one of which relates to the client’s role in healthcare services. In modern healthcare practices, clients are encouraged to take an active role in service situations. This approach aims to utilize clients’ personal expertise regarding their health and to empower them to improve their health proactively. This view of care, emphasizing client involvement, has replaced the outdated, paternalistic mindset that clients should passively trust professionals’ decisions. However, remnants of this paternalistic mindset may still be present in healthcare professionals’ attitudes and practices.

In our study, we explored the types of narratives that public healthcare professionals share about problematic interactional situations with their clients and how the client’s role appears in these narratives. We used Bamberg’s narrative positioning analysis as our analytical method, which allows us to identify how professionals position themselves in relation to their story, the interactional situation with the interviewer, and broader cultural narratives.

In healthcare professionals’ narratives about difficult interactional situations, the evaluation of clients often fell along an active–passive continuum. Professionals found client passivity challenging but also considered “overly active” clients to be burdensome. Of these two types of problematic situations, the issues arising from passivity were easier to discuss during interviews, as these issues aligned with the ideals of promoting client activity. In these narratives, client passivity was seen as hindering the achievement of care goals, sometimes to the point where the professional felt unable to help the client. On the other hand, in narratives where excessive client activity was described as causing additional workload, professionals reported being able to resolve the situations with their communication skills. However, sharing these narratives in an interview setting was challenging for the professionals, as client activity is culturally viewed as desirable. Consequently, professionals found themselves caught between the ideals of their work culture and their own paternalistic attitudes, leading them to reconcile their stories with the ideal of an active client.

Based on our research, it appears that more attention should be paid to the cultural ideals in healthcare, professionals’ capacity for reflection, and the temptations of exercising authority. Communication skills are a vital part of healthcare professionals’ expertise and strengthening them can support professionals in recognizing and reflecting on changing cultural ideals and their impact on service situations. This not only enhances the meaningfulness and smoothness of professionals’ work but also improves the quality of client encounters.

 

Read more in the open-access research publication:

Weiste, E., Stevanovic, M., Ranta, N & Nevalainen, H. (2024). Healthcare providers’ narratives about interactionally troubling patient exchanges: Accounting for and against an active patient role