Out of the clinic into the home: control and patient-physician communication

The communication of information between patient and physician is a difficult and often flawed undertaking. Although the patient may be more immediately aware of dissatisfaction with the results, the presence of incomplete or inaccurate information will ultimately affect the physician's ability to function and the quality of care he can deliver. This is an especially important problem in chronic illness where the social, psychological and environmental factors which may impinge on the illness often cannot be identified or verified by laboratory tests. The physician's need to maintain control and hence power over the patient has been suggested as an explanation for these communication difficulties. This paper examines how the home setting influences physician control by including information about the patient and his disease which the clinic context actively excludes. It argues that the loss of control which physicians experience affects communication between patient and physician and thus the quality of information obtained in that communication, and further that the information gathered is important in the care of the long term chronically ill patient.