By Sara Hoover
It’s not uncommon that a patient may not understand a doctor, especially when words
like xenotransplantation and zygomycosis are used. But when medical providers don’t
understand each other, patient care can become seriously compromised.
Two U of M English professors looked at medical communication breakdowns that occur
in patient charts and doctor-patient interaction.
Dr. Sage Lambert Graham, assistant professor of applied linguistics, and Dr. Susan
Popham, associate professor of composition & professional writing in the College of
Arts & Sciences, collaborated on an article that looked at the coherence of electronic
patient charts of an outpatient mental health facility.
Tag team: English professors Sage Lambert Graham (left) and Susan Popham examined
medical communication breakdowns that can occur because of electronic delivery methods
of patient charts. The pair also looked at doctorpatient interaction. (Photo by Lindsey
“The coherence of these charts was made more difficult or perhaps flawed in ways because
of the electronic delivery. That whole system seemed to work against coherence and
consistency in ways that we thought were perhaps problematic,” said Popham, who is
also director of the English honors program and interim English graduate coordinator.
“There were cases where one piece of information could in theory be put into different
fields,” added Graham. “So, a social worker filling out these records might be faced
with a choice for where to put one specific event. That would have implications later
on. If someone else looked at the chart, they might only look at the ‘outcomes.’ There
might be critical pieces of information they wouldn’t have access to.”
The importance of the medical teams getting information is vital to caring for patients.
“The ramifications are enormous in terms of patient outcomes,” said Graham. “You need
people who are working to get the best care possible and communication is the key
to that. If the lines of communication are compromised in anyway, patient care can
really suffer. It has real world ramifications. This kind of research is not just
something that occurs within a university on a theoretical basis; it has real world
Both were interested in medical communication breakdown since graduate school. Popham’s
master’s thesis was the rhetoric of science. Then, during her PhD time, her son got
“The rhetoric of science naturally morphed into the interest of the rhetoric of health
care and medicine,” Popham said. “I find that personally fulfilling not just because
of my son, but also because these kinds of studies make a real difference in people’s
lives. It’s a matter of life and death for much of what gets done in these kinds of
communications. That really makes a difference to put my research efforts into those
kinds of things, to see a direct benefit to people’s lives.”
Graham also became interested in health care communication during her PhD time when
a nursing college approached one of her professors about a study.
“The RNs were very frustrated working in the hospital because they didn’t feel like
the doctors, particularly the interns and the residents, took them seriously,” said
Graham. “A lot of them had 20 years of experience, and they had these young doctors
coming in, technically above them in the hierarchy of the hospital, who were dictating
patient care and not necessarily taking their input seriously.”
The joint article was published in Technical Information Quarterly, a journal for technical writers, but their target audience includes medical professionals,
caregivers and “people who have the ability to alter the types of charts or types
of electronic delivery to make information sharing easier, more efficient and more
Their hope is that organizations will enact policy changes or change the ways they
communicate for the better. Popham and Graham have also been approached to do training
sessions and have presented their findings all over the world, including Canada and
Both have used the research to branch off into individual projects as well. Graham
is working on how ethnicity intersects with provider and patient interaction.
“I’ve had doctors locally express frustration because they’re not able to communicate
with patients of other ethnicities effectively,” she said. “They’re either communicating
at cross-purposes or frustrated because the doctor thinks the patient’s not doing
what they asked or what they’re supposed to. The patient doesn’t understand what the
This cross-communication can also influence what is or isn’t recorded in electronic
“People have assumptions about how communication is supposed to go, based on their
own cultural experience and expectations,” Graham said. “The clients are African-American,
for example, and the caseworker is not. The caseworker may interpret what’s happening
or the situation in the home differently than they might otherwise. So, different
information gets entered into the chart, different information seems salient to the
plan of care.”
Popham is looking at how the authors of the charts create an authorial persona.
“Very rarely do they quote the clients or family members. When they do quote — what
we call ‘reported speech’ — it is really problematic. It’s almost like they want to
distance themselves from what these people had to say. It’s certainly a marker of
distance,” said Popham. “They really try very hard to make themselves look like experts.
They focus on themselves in ways that seems rather odd. You would expect a home visit
to focus on the client or the home, but there’s much more focus on the social worker
or the therapist as the author of these charts. They’re being rather savvy in terms
of promoting themselves. They write these charts more to make themselves look better
than with an eye towards patient or client therapy.”
Popham has also traveled to India to continue discussing this medical communication
Although there are several separate and joint projects, there is common ground.
“The common thread is that there’s tremendous potential for communicative breakdown,”
said Graham. “Whether that’s in the case of the electronic charts, spoken interaction
where people are talking at cross-purposes or they’re not able to voice their opinions
because of hierarchal structures and power differentials. If there is communicative
breakdown or obstacles to effective communication, then patient care can potentially
be compromised. That’s what all of these projects address: how is information conveyed?
What kind of obstacles to effective communication exists? How might those be addressed?”
The pair plans to present jointly at the international Communication, Medicine and
Check out the “Travel Enrichment” video at www.memphis.edu/videos to hear Graham discuss presenting their research in South Africa.