Giving voice to the lifeworld in the patient-physician interaction (PPI): A qualitative research in counseling patterns of physicians in medicating patients from the rural areas in Ardebil in the northwestern Iran

Using the theory of dialectics of medical interviews, by Elliot Mishler, which gives voice to the notion of lifeworld in the Patient-Physician Interaction (PPI), in this study the conducting and consulting patterns of physicians in communicating with, and medicating patients from rural areas of Ardabil city has been studied, where a large majority of people are ethnically Azerbaijani, and speaking in Azerbaijani Turkish language. Briefly reviewing the body of knowledge and literature on the PPI and its patterns, this article, like works of Mishler, asserted the significance of the lifeworld in the domains of medical anthropology and medical sociology. To do this, methodologically a constellation of methods including ethnographical methods, participatory observation, observing the medication process (so-called the outpatient treatment of patients at the governmental health centers or clinic by the general physicians) and also some other audio-visual evidence was used. Taking a qualitative data management approach, ten medical interviews or conversations of physicians with their rural patients in both governmental health care centers and the private clinics was comparatively typified and analyzed. The findings of this qualitative inquiry revealed that the PPI based on the voice of lifeworld capable both physicians and patients to engage with the lifeworld. In this view, the rural patients were recognized as unique human beings with further opportunities to talk in some more details about their health-related problems (The mutual lifeworld), what is rarely taken place in the private clinics of Ardebil city. The results also showed that while patient-centered pattern of PPI is very common in private clinics, in the governmental health centers of Ardebil there is no or less room for configuring the same pattern of PPI, as the majority of these centers are outpatient ones. In the governmental health centers, dominant pattern of doctor–patient communication is the physician-centered pattern. In conclusion, dominance of physician-centered pattern of PPI, in particular in the governmental treatment centers of Ardebil city, means that in these centers the importance of dealing with the concerns of the lifeworld for rural patients and voice of the lifeworld as a more humane, more effective medical care is still ignored in this part of the country.