Medical school faculty’s discursive positioning of doctors in relation to patients

BACKGROUND: An important part of doctors' identity is the social position they adopt relative to patients. Dialogic theory predicts that medical school discourses influence the positions students incorporate into their professional identities. Since this may affect how students later exercise power in doctor-patient relationships, we set out to examine how faculty position doctors in relation to patients. METHODS: Informed by Holland's Figured Worlds theory, which draws important assumptions from Bakhtin, we chose dialogic research methodology to examine how educators' language positioned doctors and might influence students' identity formation. We recruited a maximum variation sample of 10 teaching staff and used open prompts in individual semi-structured interviews to elicit discourses of doctors' social position. We used Sullivan's dialogic methodology reflexively to identify informative speech acts (utterances) and examine how language used in these constructed doctors' positions. RESULTS: Dominant discourses of Social Superiority, Technical Effectiveness, and Benevolence elevated doctors' positions based on their social status, applied knowledge, and trustworthiness respectively. These positions were defended by predicating medical care on doctors' mastery of treatments and their superior knowledge. A non-dominant discourse of Distributed Power and Responsibility narrowed the positional gap by constructing doctors as empowering patients. CONCLUSIONS: Whilst three conservative discourses upheld doctors' elevated social position, a non-dominant, transformative discourse distributed power. We suggest that doctors will form the best relationships with patients when they are aware of these discourses and know how to navigate them. In pursuit of effective and compassionate patient care, we commend critical pedagogy as a means of articulating non-dominant discourses and increasing students, educators, and doctors' awareness of how they learn the positions of doctors.