Yoshio KASHIDA 1)
Setsunan University Department of Contemporary Social Studies
“Context” is important in medical communication. In recent decades, the omnipotence of “medical context” has diminished, and the importance of “context raised by the patient” has increased. In this paper, I explain two images of communication (the “transmission/signal image” and the “sharing/understanding image”) as a theoretical framework. These two images are two images of a single model. This framework suggests that the “speed and depth of communication” may not represent a binary opposition. Thus, if “depth” is achieved by reaching an extraordinary level of understanding, there is no need to assume a trade-off with “speed.” On the basis of Mitsuhiro Okada’s discussion of X-ray interpretation, I argue that this assertion supports the notion that interprofessional communication can be both fast and deep, while also asserting that “deep” communication is possible even within the “transmission/signal image.” As a second example, I examine communication in which shared understanding did not initially appear to be established. However, the communication ultimately led to a shared understanding. While this case was patient-led, it may be necessary for medical professionals in future to be able to respond to such “unusual communication.” This paper provides a tentative discussion on medical communication, and suggests that research and training programs that experimentally examine communication in real-world scenarios may be useful. We hope to examine this issue further in future studies.
Junichiro Miyachi 1)2)
1) Center for Medical Education, Nagoya University
2) Hokkaido Centre for Family Medicine
Communication among healthcare professionals is as important as communication between healthcare professionals and patients. The current paper focuses on case discussions in which multiple healthcare professionals engage in conversations about individual patients’ care in clinical settings. Communication between healthcare providers and patients is often framed in terms of two contrasting aspects: transmission of medical information related to diagnosis, care, and treatment, and co-construction of meaning between healthcare professionals and patients. In this article, I refer to these perspectives as the “information transfer model” and the “meaning-co-construction model,” respectively. Emphasizing the importance of the meaning-co-construction model in communication among healthcare professionals, I examine how case discussions can be revisited through the meaning-co-construction model. To this end, two examples are discussed: the Collaborative Clinical Case Conference (CCCC) model developed by the author with cultural and medical anthropologists, as an example of multi-participant discussions, and the Conversations Inviting Change, as an example of one-onone supervisions. Finally, I consider how approaches to case discussions informed by the meaning-co-construction model can be characterized, with particular attention to the roles of cases and questions.
Hirotaka ONISHI1)
1) Department of International Cooperation for Medical Education, International Research Center for Medical Education, Graduate School of Medicine, The University of Tokyo
In this article, clinical reasoning is redefined from a diagnostic reasoning process to a comprehensive sequence of reasoning that begins with the patient’s complaint and extends to problem-solving, care, and support. When patients seek help, identifying the cause of symptoms is not sufficient; resolution or meaningful improvement is essential. The post-diagnostic reasoning process is conceptualized as “therapeutic/management reasoning,” which, like diagnostic reasoning, involves both cognitive and dialogical elements. The author proposes the Three-Layer Cognitive (TLC) model, which structures clinical reasoning into three phases: (1) identifying the target of intervention, (2) clinical decision-making for the intervention, and (3) implementing and evaluating the intervention. This model enables all healthcare professionals other than physicians to share a common framework for reasoning. A case study illustrates how therapeutic/management reasoning was applied after diagnosis through enhancement of the patient’s self-care capacity and shared decision-making with a parent. This multifaceted support demonstrates that reasoning in clinical practice extends beyond diagnosis alone. By framing clinical reasoning as an integrative practice in which knowledge, dialogue, and contextual understanding intersect, this paper provides a new perspective to guide future education, practice, and theoretical development.
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