ABSTRACT
The more things change, the more they stay the same. The U.S. health-care system has undergone enormous technological and organizational change over the past few decades (Geist-Martin et al., 2003) and yet remains remarkably inflexible and static in terms of its disciplinary hierarchies, organizational power structures, and day-to-day communication practices that both arise from and perpetuate those hierarchies and structures (Ellingson, 2005). The current U.S. medical system is neither natural nor neutral; it is the result of specific historical events, and it perpetuates a rigid hierarchy among health-care providers and between providers and patients (Ehrenreich & English, 1973; Foucault, 1973). Power in the medical establishment involves complex contemporary and historical intersections of race, gender, class, sexuality, educational level, and able-bodied privileges and oppressions (Wear, 1997). Historical inequities have engendered communication norms within health care that often serve neither patients nor health-care providers effectively. Such ineffectual norms persist despite important changes in health-care delivery and in the populations who are served.
