The Challenge of Power
The studies reported here illustrate that power relationships among providers change routinely throughout the day as they find themselves in positions of higher or lower power depending on who they are working with and what values are privileged within the culture.
The structure is also difficult for medical and nursing students, who struggle to prove themselves in their interactions with patients, peers, and supervisors, often feeling caught in the middle of what appear to be competing interests related to procedures, economics, efficiency, and the emotional needs of the patient. These students are expected to model the communication and interactions of their mentors and supervisors and are socialized into a medical culture that reifies and reinforces power differences and prevents systemic change. Future research must include theories of institutional, professional, and organizational culture, as well as theories of change, to develop recommendations for integrating new forms of communication into health care practice from both the bottom-up and the top-down.Patient-centered care models that emphasize the medical encounter as a collaborative practice between providers and patients seem to be headed in the right direction—suggesting that each party must respect and acknowledge the experience of the other, while simultaneously maintaining their individual accountability for the process and outcome. This general advice not only is appropriate for the provider-patient relationship but also works for the inter- and intragroup conflicts described as well. While this may be easier said than done, communication scholars can model this practice by conducting engaged scholarship in which the researcher, provider, and patient are equal partners in a collaborative research process. Just as collaborative medicine honors the knowledge of the patient and may lead to enhanced medical practice, more collaborative research should lead to new and exciting questions and improved recommendations (see Campus Community Partnerships for Health, http://www.ccph.info/, for examples of engaged research).