Information control and the micropolitics of health care: summary of an ongoing research project.

Abstract Policy changes suggested by “macro” research on the medical care system will not in themselves correct critical gaps and misunderstandings that persist at the “micro” level of the doctor-patient relationship. This paper presents a summary of an ongoing research project concerning one element of this relationship—the doctor's communication of information about illness to the patient. Information transmittal is closely related to the clinical problems of history taking, medical records, compliance, satisfaction, physiologic response to therapy and patient delay in reporting symptoms. The sociological considerations guiding the research are summarized under four headings: (1) the problems of uncertainty and power; (2) the definition of information; (3) sociolinguistics and the diffidence of the sick poor; and (4) ethnomethodology and common-sense constructs. The doctor-patient relationship is viewed as a micropolitical situation, in which information control is used, at least in part, to maintain patterns of dominance and subordination. The over-all methodological objective of the research project is to develop a research design, linked to these sociological perspectives, which allows reproducible and generalizable conclusions about the informative process in a variety of clinical settings. Based on a pre-test,a multivariate model has been operationalized; an association is hypothesized between transmitted information—the dependent variable—and several independent variable, which are classified as physician characteristics, patient characteristics, and situational characteristics. The measures of the dependent and independent variables, sampling procedures, and approach to data analysis are described. Questionnaire materials are presented in appendices.