IDEAS home Printed from
   My bibliography  Save this article

Giving voice to the lifeworld. More humane, more effective medical care? A qualitative study of doctor-patient communication in general practice


  • Barry, Christine A.
  • Stevenson, Fiona A.
  • Britten, Nicky
  • Barber, Nick
  • Bradley, Colin P.


Mishler (The discourse of medicine. The dialectics of medical interviews. Norwood, NJ: Ablex), applying Habermas's theory of Communicative Action to medical encounters, showed how the struggle between the voice of medicine and the voice of the lifeworld fragmented and suppressed patients' multi-faceted, contextualised and meaningful accounts. This paper investigates and critiques Mishler's premise that this results in inhumane, ineffective medical care. Using a more complex data collection strategy, comprising patient interviews, doctor interviews and transcribed consultations we show more complex relations than emerged from Mishler's analysis. We found four communication patterns across 35 general practice case studies. When doctor and patient both used the voice of medicine exclusively (acute physical complaints) this worked for simple unitary problems (Strictly Medicine). When both doctor and patient engaged with the lifeworld, more of the agenda was voiced (Mutual Lifeworld) and patients were recognised as unique human beings (psychological plus physical problems). Poorest outcomes occurred where patients used the voice of the lifeworld but were ignored (Lifeworld Ignored) or blocked (Lifeworld Blocked) by doctors' use of voice of medicine (chronic physical complaints). The analysis supports the premise that increased use of the lifeworld makes for better outcomes and more humane treatment of patients as unique human beings. Some doctors switched communication strategies in different consultations, which suggests that their behaviour might be open to change. If doctors could be sensitised to the importance of dealing with the concerns of the lifeworld for patients with chronic physical conditions as well as psychological conditions, it might be possible to obtain better care for patients. This would require attention to structural aspects of the healthcare system to enable doctors to work fully within the patient-centred model.

Suggested Citation

  • Barry, Christine A. & Stevenson, Fiona A. & Britten, Nicky & Barber, Nick & Bradley, Colin P., 2001. "Giving voice to the lifeworld. More humane, more effective medical care? A qualitative study of doctor-patient communication in general practice," Social Science & Medicine, Elsevier, vol. 53(4), pages 487-505, August.
  • Handle: RePEc:eee:socmed:v:53:y:2001:i:4:p:487-505

    Download full text from publisher

    File URL:
    Download Restriction: Full text for ScienceDirect subscribers only

    As the access to this document is restricted, you may want to search for a different version of it.


    Citations are extracted by the CitEc Project, subscribe to its RSS feed for this item.

    Cited by:

    1. Waring, Justin & Latif, Asam & Boyd, Matthew & Barber, Nick & Elliott, Rachel, 2016. "Pastoral power in the community pharmacy: A Foucauldian analysis of services to promote patient adherence to new medicine use," Social Science & Medicine, Elsevier, vol. 148(C), pages 123-130.
    2. Gately, Claire & Rogers, Anne & Sanders, Caroline, 2007. "Re-thinking the relationship between long-term condition self-management education and the utilisation of health services," Social Science & Medicine, Elsevier, vol. 65(5), pages 934-945, September.
    3. Daker-White, Gavin & Rogers, Anne & Kennedy, Anne & Blakeman, Thomas & Blickem, Christian & Chew-Graham, Carolyn, 2015. "Non-disclosure of chronic kidney disease in primary care and the limits of instrumental rationality in chronic illness self-management," Social Science & Medicine, Elsevier, vol. 131(C), pages 31-39.
    4. Lo, Ming-Cheng Miriam & Bahar, Roxana, 2013. "Resisting the colonization of the lifeworld? Immigrant patients' experiences with co-ethnic healthcare workers," Social Science & Medicine, Elsevier, vol. 87(C), pages 68-76.
    5. May, Carl & Rapley, Tim & Moreira, Tiago & Finch, Tracy & Heaven, Ben, 2006. "Technogovernance: Evidence, subjectivity, and the clinical encounter in primary care medicine," Social Science & Medicine, Elsevier, vol. 62(4), pages 1022-1030, February.
    6. Leanza, Yvan & Boivin, Isabelle & Rosenberg, Ellen, 2010. "Interruptions and resistance: A comparison of medical consultations with family and trained interpreters," Social Science & Medicine, Elsevier, vol. 70(12), pages 1888-1895, June.
    7. Williams, Kevin Frank, 2007. "Re-examining 'professionalism' in pharmacy: A South African perspective," Social Science & Medicine, Elsevier, vol. 64(6), pages 1285-1296, March.
    8. repec:eee:socmed:v:207:y:2018:i:c:p:71-79 is not listed on IDEAS
    9. Ariss, Steven M., 2009. "Asymmetrical knowledge claims in general practice consultations with frequently attending patients: Limitations and opportunities for patient participation," Social Science & Medicine, Elsevier, vol. 69(6), pages 908-919, September.
    10. Lynch, Johanna M. & Askew, Deborah A. & Mitchell, Geoffrey K. & Hegarty, Kelsey L., 2012. "Beyond symptoms: Defining primary care mental health clinical assessment priorities, content and process," Social Science & Medicine, Elsevier, vol. 74(2), pages 143-149.


    All material on this site has been provided by the respective publishers and authors. You can help correct errors and omissions. When requesting a correction, please mention this item's handle: RePEc:eee:socmed:v:53:y:2001:i:4:p:487-505. See general information about how to correct material in RePEc.

    For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: (Dana Niculescu). General contact details of provider: .

    If you have authored this item and are not yet registered with RePEc, we encourage you to do it here. This allows to link your profile to this item. It also allows you to accept potential citations to this item that we are uncertain about.

    We have no references for this item. You can help adding them by using this form .

    If you know of missing items citing this one, you can help us creating those links by adding the relevant references in the same way as above, for each refering item. If you are a registered author of this item, you may also want to check the "citations" tab in your RePEc Author Service profile, as there may be some citations waiting for confirmation.

    Please note that corrections may take a couple of weeks to filter through the various RePEc services.

    IDEAS is a RePEc service hosted by the Research Division of the Federal Reserve Bank of St. Louis . RePEc uses bibliographic data supplied by the respective publishers.