Abstract
Communication in the field of healthcare involves various actors such as patients, families, doctors and co-medical staff. The relationships among these actors and their power politics have been examined in research in the field of sociology of medicine. Recent changes in the social environment and policies related to healthcare have placed new actors on the healthcare communication stage. In this article, I first define the concept of "advocacy" and then discuss roles in the medical profession, especially the roles played by the co-medical staff in healthcare communication from the viewpoint of enhancing rights protection and patient advocacy. Next, I examine the impact on the patient-doctor relationship of the market-oriented healthcare reform that began in the 1980s in the U.S.. This reform enabled insurance companies to control the treatment choices that a doctor could offer to a patient. The power and autonomy of doctors seem to be declining, while insurance companies and organizations are gaining power as they increasingly intervene in the communication process between patients and doctors. It is clear that this fluctuation in the autonomy of doctors is not necessarily beneficial to their patients. Although doctors' professional autonomy was the source of their domination and paternalism in healthcare, and sometimes attracted criticism from patients, now the role of doctors and their professionalism should be redefined toward an improvement of patient advocacy. In Japan, however, the possibility of such dynamic healthcare reform is remote. The U.S. case shows us that people who intend to improve patient advocacy in the Japanese healthcare system should be sensitive and come up with a strategy for adapting to change in the social and economic environment of healthcare. Finally, I propose a more flexible framework, one that is not founded on a conflict-based approach to communication in healthcare, and in which co-medical personnel play the role of patient advocates.
