| Summary: | Patient Partnership Strategy (1996) and the NHS Plan (2000) formalised the notion of partnership and participation by the patient in both their own care and the delivery of services. This suggested that professionals in the NHS are not just givers of care but should be able to empower clients and involve them in the care planning. On a macro-political level, government policy is recommending that clients be involved directly with all levels of care. Traditionally, professionals working with clients have been, because of their professional status, regarded as powerful persons. In order, therefore, to achieve partnership with clients and meet government guidelines there would have to be a shift in the balance of power.
This paper explores on a micro-level the health visitor and client relationship by undertaking an empirical investigation of the dynamics of clinical conversations. The concepts of power, empowerment and feminism, particularly those of Foucault, are also explored to determine where the balance of power lies within these encounters. The methodology utilized includes linguistic markers such as interruptions and the use of the lifeworld voice and the voice of medicine to determine features of conversational dominance.
Some evidence of partnership and empowerment with the client was found but a predominance of the voice of medicine and a high ratio of interruptions meant the consultations resulted in conversations that were asymmetrical and illustrated the power of health visitors. The conversations highlighted their ability to dominate and control the communication through the use of discourse strategies. This would suggest that there is a wide gap between the claimed macro-politics of government policy on partnership and empowerment and its implementation at practice level.
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