PUBLIC KNOWLEDGE AND PRIVATE DISCOURSE: AN ANALYSIS OF INTERNAL RHETORIC IN THE HEALTH CARE SYSTEM

RALPH EDWARD KNUPP, Purdue University

Abstract

This study examines the relationship between one social sub-system, health care delivery, and larger society. The health care system is no longer then unquestioned guardian of the public's physical well-being. In recent years, there has been a change in public perception about health care delivery, a change which creates a new rhetorical situation for medical leaders. This study examines one aspect of the new rhetorical situation, the internal discourse of the health care system, to see how its members "make sense" among themselves of their social and political relationships. The exploration involves two fundamental questions: (1) As public perceptions of the health care system have changed, how, if at all, has the internal discourse of the system changed to maintain a "steady state?" (2) How do different professionals in the health care system view and discuss their socio-political relationships and responsibilities? The purpose of this study was to examine one form of internal discourse in the health care system in order to explicate patterns of rhetorical adjustment to changes in the external environment. To achieve it, ninety messages from the professional journals of physicians, nurses, and hospital administrators were analyzed by means of Toulminian, judgmental, and DICTION analytical methods. The messages were selected from 1957 - 1958 and 1977 - 1978 issues of the American Journal of Nursing, Hospitals, and the Journal of the American Medical Association. They were chosen because they addressed socio-political issues, as opposed to technical issues. As a background for this analysis, an extensive theoretical perspective was developed by integrating phenomenology, oganizational research, the sociology of knowledge, and rhetorical perspectives on social reality. Likewise, a historical sketch of the health care system, which focused on the professional development of physicians, nurses, and hospital administrators, was delineated. Several major findings emerge from this study. While physicians, nurses, and hospital administrators function in the same physical environment, they live in radically different symbolic worlds. Only hospital administrators directly confront the issue of change in the external environment through their rhetoric. They argue the necessity of cooperation among professionals, public, and government for the solution of current problems. Physicians and nurses, by contrast, avoid the issue of changing public perceptions. Only hospital administrators exhibit a coherent organizational image. They view health care delivery as a cooperative enterprise among professionals, while nurses and physicians display more individualistic perceptions. There is a commonly shared perception that the future of health care delivery is highly uncertain and problematic in the messages of 1977-78. This perception stands in marked contrast to the relative certainty in the messages of 1957-58. Finally, there is a commonly shared perception that government intervention in health care will increase. Physicians view this trend with alarm. Nurses and hospital administrators see government as a potential ally. These findings suggest that disparities in the rhetorical worlds of health care professionals are likely to frustrate attempts to resolve current health care problems. Likewise, these disparities are likely to contribute to continued public scepticism about the motives and values operative in the health care system.

Degree

Ph.D.

Subject Area

Communication

COinS