Skip to main content

Bridging the discursive gap between lay and medical discourse in care coordination

Sheaff, Rod, Halliday, Joyce, Byng, Richard, Øvretveit, John, Exworthy, Mark, Peckham, Stephen, Asthana, Sheena (2017) Bridging the discursive gap between lay and medical discourse in care coordination. Sociology of Health & Illness, 39 (7). pp. 1019-1034. ISSN 0141-9889. E-ISSN 1467-9566. (doi:10.1111/1467-9566.12553) (KAR id:61277)


For older people with multiple chronic co-morbidities, strategies to coordinate care depend heavily on information exchange. We analyse the information-sharing difficulties arising from differences between patients’ oral narratives and medical sense-making; and whether a modified form of ‘narrative medicine’ might mitigate them. We systematically compared 66 general practice patients’ own narratives of their health problems and care with the contents of their clinical records. Data were collected in England during 2012–13. Patients’ narratives differed from the accounts in their medical record, especially the summary, regarding mobility, falls, mental health, physical frailty and its consequences for accessing care. Parts of patients’ viewpoints were never formally encoded, parts were lost when clinicians de-coded it, parts supplemented, and sometimes the whole narrative was re-framed. These discrepancies appeared to restrict the patient record's utility even for GPs for the purposes of risk stratification, case management, knowing what other care-givers were doing, and coordinating care. The findings suggest combining the encoding/decoding theory of communication with inter-subjectivity and intentionality theories as sequential, complementary elements of an explanation of how patients communicate with clinicians. A revised form of narrative medicine might mitigate the discursive gap and its consequences for care coordination.

Item Type: Article
DOI/Identification number: 10.1111/1467-9566.12553
Uncontrolled keywords: care coordination, informational continuity of care, general practice, England, electronic patient record, patient discourse, narrative medicine
Subjects: H Social Sciences > HM Sociology
Divisions: Divisions > Division for the Study of Law, Society and Social Justice > School of Social Policy, Sociology and Social Research > Centre for Health Services Studies
Depositing User: Stephen Peckham
Date Deposited: 13 Apr 2017 10:54 UTC
Last Modified: 29 Oct 2021 14:37 UTC
Resource URI: (The current URI for this page, for reference purposes)

University of Kent Author Information

  • Depositors only (login required):

Total unique views for this document in KAR since July 2020. For more details click on the image.