Open AccessDuring recent decades there has been an increasing claim for patient participation and shared decision-making in health services across the Western world. Focus on participation recasts the relationship between healthcare providers and their patients. Professionals are compelled to acquaint themselves with new worldviews, new ways of understanding illness and disease, and to communicate with patients with language, religion and cultural backgrounds increasingly different from their own.
Contested concepts such as communication, tolerance, participation and shared decision-making emerge, as do claims about non-participation, oppressive practice and muting of patients. In this article we look into how the paternalistic tenets of intercultural communication, tolerance and the culture of medicine intersect in such ways that empowerment and shared decision-making in health can be constrained. Modern day health concerns such as lifelong disabilities or chronic illness have multiple faces, and there is no one agreed-upon approach to assessment, treatment or non-treatment. Patients and providers have to engage in communication to detect enablers and constraints, bodily and socially. If communication is envisioned as a one-way delivery of knowledge or prescriptions, or a difference in culture is magnified to a degree that other characteristics fade away, the patient risks oppression, muting, and poor healthcare.
We argue in favour of appropriating a critical perspective on interaction in healthcare and intercultural communication, and in favour for interpreting face-to-face interaction as situated social practice. A situated social practice compels those present to communicate to create an agreed-upon situational definition, and to enter into a recuperative dialogue where patients too may exercise agency and present themselves as empowered.
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