Bridging the discursive gap between lay and medical discourse in care coordination

Area of Science:

• Health Services Research
• Medical Communication
• Geriatric Care

Background:

• Effective care coordination for elderly patients with multiple chronic conditions relies on seamless information exchange.
• Discrepancies between patients' personal health stories and their formal medical records pose significant challenges.

Purpose of the Study:

• To analyze information-sharing difficulties stemming from the divergence between patients' oral health narratives and clinicians' medical interpretations.
• To investigate if a modified narrative medicine approach can alleviate these difficulties and improve care coordination.

Main Methods:

• Systematic comparison of 66 general practice patients' self-reported health narratives with their corresponding clinical records.
• Data collection conducted in England between 2012 and 2013.

Main Results:

• Significant differences were observed between patient narratives and medical records, particularly concerning mobility, falls, mental health, and frailty.
• Patient viewpoints were often lost, misinterpreted, or reframed during the clinical encoding process.
• These discrepancies limited the utility of patient records for risk stratification, case management, and overall care coordination.

Conclusions:

• The study highlights communication barriers in healthcare, suggesting a need for improved patient-clinician information exchange.
• Integrating communication theories (encoding/decoding, inter-subjectivity, intentionality) can explain these discrepancies.
• A revised narrative medicine strategy holds potential for mitigating the discursive gap and enhancing care coordination for complex patient populations.