Care, communication and conversation.

The professionalisation of care has resulted in ever increasing specialisation, use of technical innovations and informatisation. This has had consequences for the level and way of involvement of the care provider vis-a-vis the patient. The result has been growing alienation on the part of the patient and flight into non-classical medicine, as well as frustration on the part of medical personnel, likewise with respect to the reactions of patients. A solution is usually sought in more communication. This might be styled the professional answer to alienation and frustration, whereby 'the human factor', it is hoped, can be better accounted for. Enhanced communication implies two elements: 1) to better cater for the feelings of patients by trained communicators, i.e. more openness, more client satisfaction; 2) to better take into account patient rights and to actually implement them. The question is whether measures in terms of communication, geared at enhancing client satisfaction and the implementation of patient rights, are the real answer to the above mentioned alienation and frustration. Perhaps the trouble has deeper reasons and requires taking other dimensions into account such as decency and human dignity, which cannot be captured simply in terms of satisfaction and rights. This would mean that the answer must be sought at a deeper level than communication. This level might be called 'conversation' (using a concept analysed by Michael Oakeshott). In the second part of the paper, the possible relationship between care and conversation will be briefly analysed.