A Summary of How The VA System Can Improve in the Rhetoric of Concordance
Posted on June 27th, 2021 by Justin Sowell
In this blog post, titled “A Summary of How The VA System Can Improve in the Rhetoric of Concordance”, I will review how the patient and physician can work together in treating patient illness instead of strictly physician-led treatment. As a Marine Corps Veteran who has found concordance in patient-physician relationships within the VA System a rare commodity; I felt it was time to consider how rhetoric in the medical and health field might stimulate the conversation to increase patient involvement in the treatment plan. I will be reviewing; “Is the genre extant? The curious case of psychiatry’s case history” by Carol Berkenkotter; “Health and the Rhetoric of Medicine” by Judy Segal; “Recognizing Differences and Commonalities: The Rhetoric of Health and Medicine and Critical-Interpretive Health Communication” by John A. Lynch and Heather Zoller; “In Search of Patient Agency in the Rhetoric of Diabetes Care” by M.S. Stone, and “Innovation and design streamlines Veteran access to mental healthcare” by VHA Innovation Ecosystem.
The Rhetoric of the Clinical Gaze
Clinical gaze describes the lens used by physicians in much of the health and medical industry in which a disease or illness is viewed separately from the identity of the individual patient. The physicians' focus is on treating the disease or illness rather than treating the patient as a person. As more patients share an illness or disease; data is collected in terms of symptoms and treatment methods. In “Is the genre extant? The curious case of psychiatry’s case history” Carol Berkenkotter states, “generalizations based on multiple cases could be considered objective and “evidence-based” (i.e., statistical) in a way that the narrative analysis of a single individual’s problems and emotional difficulties could not.” (64). Although a physician might get to know their patient as treatment progresses, the clinical gaze often reduces the patient-physician relationship to one simply of adherence or compliance; where a patient simply follows doctors' orders.
It is not difficult to see how a large organization with many patients, like the VA System, might rely on a compliance standard as a means to streamline care across the organization. In “In Search of Patient Agency in the Rhetoric of Diabetes Care” Stone argues that “The goal of disease management is for a managed health care organization, one that provides a combination of prepaid medical insurance and health services delivery, to spend the least amount of money while achieving the best possible patient outcomes.” (205). The VA System is the exact type of organization Stone is defining in that much of the health care costs come out of the VA’s funding and are not supplemented through additional means. This means that the VA System has to reduce operational costs while trying to streamline care for all patients and seek positive outcomes in the process.
The Rhetoric of Patient-Physician Concordance
The term “concordance” seems to be a fairly modern construct in genre rhetoric attempting to shift patient-physician relationships away from the more common “adherence” and “compliance” in which patients simply follow orders given from physicians. In “Health and the Rhetoric of Medicine” Judy Segal reviews this phenomenon in detail. Segal states of concordance, “The recent literature has a new regard for the patient, overall promoting the idea of the patient as an equal partner with the physician and a rational decision maker in matters of treatment.” (Location 1902). The VA System seems to widely operate through the previously discussed clinical gaze. However, as Segal suggests, with newer literature focusing more a shift towards concordance and away from compliance patient-physician relationships then perhaps it is time to consider ways in which rhetoric can persuade a dynamic shift towards concordance within the VA System itself.
In “Innovation and design streamlines Veteran access to mental healthcare” by VHA Innovation Ecosystem, they tell the story of a Veteran and his spouse as they navigate the VA System seeking assistance for his mental health condition. They are sent through a maze of bureaucracy before a patient advocate was able to reroute them correctly to a psychologist. The article states, “Unfortunately, this is too common an experience, for both Veterans and Dr. Buckholdt” (2018). Many veterans find themselves having to seek patient advocates or veteran service organizations that will advocate on their behalf to ensure the Veteran is able to receive the proper help they need.
In “Recognizing Differences and Commonalities: The Rhetoric of Health and Medicine and Critical-Interpretive Health Communication” John Lynch and Heather Zoller review scholarly work around health communication and ways in which to improve rhetoric in the field moving forward. They argue, “we encourage closer engagement and collaboration between qualitative communication research and rhetorical perspectives of health and medicine.” (502). There is a major shift happening within the VA System to improve the quality and efficiency of care for the nation's veterans. One of the most productive means for improving care within the medical and healthcare industry is through scholarly work which encourages physicians and medical institutions to make meaningful change. A dynamic shift in veteran-centric research in health and medicine should encourage more concordance within the VA System.
Works Cited
Berkenkotter, C. (2011). Is the genre extant? The curious case of psychiatry’s case history. In J. Leach & D. Dysart-Gale (Eds.). Rhetorical questions of health and medicine (pp. 59–75). Lanham, MD: Lexington Books.
Segal, J.Z. (2005). Health and the Rhetoric of Medicine. Southern Illinois University Press.
Lynch, J. A., & Zoller, H. (2015). Recognizing Differences and Commonalities: The Rhetoric of Health and Medicine and Critical-Interpretive Health Communication. Communication Quarterly, 63, 498–503.
Stone, M. S. (1997). In Search of Patient Agency in the Rhetoric of Diabetes Care. Technical Communication Quarterly, 6(2), 201–217. https://doi.org/10.1207/s15427625tcq0602_5
VHA Innovation Ecosystem. (2018, February 15). Innovation and design streamlines Veteran access to mental healthcare. Medium. https://medium.com/vainnovation/innovation-and-design-streamlines-veteran-access-to-mental-healthcare-e5407ea2b97a.