Enhancing physicians’ communication skills is not enough: an approach by Habermas social theories

Introduction: A high gap of communication between physicians and patients has been widely documented. Based on Habermas, communication problems originally came from systematization and technology, in which these conditions lead physicians to form inappropriate communications called ‘strategic action’ (SA). To avoid communication conflicts, Habermas promotes the ‘communicative action’ (CA) The objective of this study was to prove theoretical conditions of occurrences of SA and CA in physicians’ thoughts.

Methods: Samples were collected from in-training physicians at King Chulalongkorn Memorial Hospital. A self-administered, Thai-version, questionnaire was the study tool. The questionnaire was composed of eight scales that were constructed and qualified. A theoretical model of multiple relationships causing SA and CA was tested by path analysis.

Results: The total respondents were 173. Analyzed data indicated the theoretical model was valid (RMSEA = 0.000). Conditions that significantly influenced SA were ‘medical ideology (MI)’ (total effect = 0.10), ‘system ideology (SI)’ (total effect = 0.09) and ‘cognitive-instrumental rationality’ (total effect = 0.30). Conditions that significantly influenced CA could not be identified. Based on the theory, ‘morality ideology should influence moral-practical rationality’, but ‘system ideology’ was found to significantly influence instead (path coefficient= 0.25).

Discussion: The ‘technocratic ideology’ (MI and SI) together with the cognitive-instrumental rationality was proved to lead physicians’ SA. These findings confirmed 1) the significance of thoughts that base personal actions and 2) an extension of systematization that influenced on moral rationality. Probably, this influence might obstruct the natural moral developments so that CA could not be developed. In other words, systematization facilitates SA.

Conclusion: Physicians communications were fundamentally SA because of continuing embedded ‘technocratic ideology’. Therefore, solving physicians’ inappropriate communication should realize the significance of ideology and rationality levels, such as, cessation of embedding ‘technocratic ideology’.