Perspectives on power, communication and the medical encounter: implications for nursing theory and practice

Over the past few decades there has been an increasing push towards 'enhancing' communication in the medical encounter, with a focus on moving towards a 'mutuality' of patient and health care professional that reduces a perceived 'power imbalance' between the two. Doctors in particular have been constructed as dominating and coercive, either consciously or unconsciously repressing patients' capacity for autonomy. Nurses have typically been represented as less authoritarian in their dealings with patients in their idealized role as caring, kindly and empathetic health professionals. It is therefore often argued that the nurse-patient relationship is more 'equal' and less repressive than the doctor-patient relationship. This article explores critically these assertions in the context of the Foucauldian perspective on the role of power in the medical encounter, and draws out implications for nursing theory and practice.