The Discourse Community of Rural Medicine
A discourse community is “a group of people who share ways to claim, organize, communicate, and evaluate meanings” (Schmidt and Kopple 1). In other words, a discourse community is a group of people engaging in a topic of interest. Your friends, your family, your major field of study constitute a discourse community. A discourse community has an agreed set of ultimate purposes or goals. A group of biology students have common goals—to navigate the study of life and living organisms. A discourse community has varying forms of communications. For example, you will communicate with your friends in a different manner than communicating with your professors. Generally, we will text our friends and write papers and send emails for our professors in regards to the same topic. At home we learn to communicate in a different way that may be deemed as inappropriate in a professional/work/school setting. So how do we effectively communicate with different discourse communities? It all boils down to the art of rhetoric, “an art that enhances communication both within and between discourse communities” (Schmidt and Kopple 3). In my words, I think this means to step outside your discourse community and acknowledge the differences in order to comprehend the purpose of another discourse community. These groups of individuals develop and construct their own line of communication to address their needs that need to come to fruition to advance their main objective. For example, there are strikingly differences within the culture of medicine and each difference leads to a unique discourse community within the medical realm.
Over the past decades, rural medicine has evolved their own unique way of interacting with physicians and their patients. Dr. Acosta states, “I had to learn one language that got to the people because they would not understand what I was talking about. The flipside of that is that I also had to learn language by talking to the other physicians” (Acosta). Learning these two languages are an integral part of rural health discourse communities. Rural health care providers must be able to provide top quality, up to date services to the population, often go to the community to bring awareness of certain illnesses, and must be able to connect with a wide variety of people in the population. Dr. Acosta compares a rural area to a mixed bag which contains professors, teachers, high school dropouts, migrant farmworkers, etc. Bushy notes that there is no common culture among rural patients. Bushy states, “Every rural community is unique, with its own special (sub)groups’” (Bushy 255). Even with these differences, Dr. Acosta and Author Bushy agree that less populated areas experience disparities in regards to health care. Thus, it is imperative to provide health care that is appropriate to address the differences in socioeconomic status. Compared to their urban counterparts, rural health clients suffer from unique social, economic, and geographic elements in addition to shortages of health care professionals. It is these set of characteristics, along with others, which sets apart rural medicine from the broader medical field.
Rural medicine is a discourse community established within the medical field that caters to vulnerable populations that reside in areas with shortages of health professional. For this reason, rural patients tend to have poorer outcomes in their health compared to their urban counterparts. An all-encompassing definition of the term rural is one that includes both low “population density and cultural variations for the people who live there” (Bushy 255). Rural areas tend to have less than 100 people per square mile, are isolated, and have sparse resources. These underserved areas continue to grow every year, requiring more and more health care professionals to address the issues these communities face. The rural health discourse community does this through the use of different types of genres, genres defined as the “distinctive category of discourse of any type, spoken or written, with or without literary aspirations” (Swales 33). The genres to be examined in this study involve a large variety of literacies used within rural communities. The study of this discourse community is of interest to me, as I have been a part of a rural upbringing from a young age. Although I was raised in a rural area most of my life, it was only by studying rural health discourse communities where I began to understand severity of the issues present in many rural settings.
I conducted an interview with Dr. David Acosta, a family medicine physician who has eight years of experience working in rural communities. Through an interview with Dr. David Acosta, I identified many of the of the genres the rural health community utilize to address issues evident in these rural settings such as, “availability of services, accessibility of services and acceptability of services” (Bushy 257-259). I began to take note of the different forms of communication and lexis the rural community utilizes in its inner workings. The main, overall objective of the interview was to inquire of the main genres that Dr. Acosta was exposed to during his interactions in a rural environment. Additionally, I wanted to learn about the forms of communication the health professionals used to communicate with other physicians and patients and to discuss whether they were effective in furthering the aims of rural medicine.
In addition to the interview, I researched a scholarly article written by Angeline Bushy and a grant writing blueprint offered by the National Rural Health Resource Center. The main objective of the scientific article was to inquire the issues many rural health professionals encounter when delivering health care in rural areas. Using the interview and the article, I was able to note many common themes laden in both sources. From these two sources, I was able to extract the values these two communities possess, along with genres utilized within this discourse community.
To better comprehend the reasoning behind the genres used by the rural practitioners, it is important to understand the main goals of the community. Rural communities often lack a voice and many times become unheard outside their environment. Much of the patient community does not have the knowledge required to navigate the complex health care system. Thus, it is crucial that health professionals advocate on their behalf. Dr. David Acosta noted the importance of being a voice to unheard communities by learning how to write federal grants in order to help pay for resources needed by these underserved communities. Bushy acknowledge that “access to public and private sources of funding can be hampered by the lack of grant-writing skills on the part of rural providers” (Bushy 259). Furthermore, Dr. David Acosta noted the grant-writing disparity present in many small communities. Dr. David Acosta states, “One of the things that I had to learn pretty quickly was how to acquire those grant-writing skills because I certainly didn’t get them in medical school or in residency either” (Acosta). To address this disparity, state health departments are beginning to offer seminars on grant writing to help provide these vital skills necessary to fund a project. In Dr. David Acosta’s case, he was privileged to have a wonderful grant writer who showed him how to articulate his thoughts in order to put his vision into words, enabling him to learn the language, the terminology necessary to convince the grant reviewers to fund his project. Others may not be as fortunate as Dr. David Acosta and may need to reserve to other sources to accomplish the same goal.
Above is a snapshot of a grant writing checklist issued by the National Rural Health Center to aid grant applicants to write a federal grant proposal. The chart below highlights numerous components rural practitioner’s must contemplate to successful write a federal grant. For instance, the grant writer must have a level of rhetorical knowledge to persuade the grant reviewer to approve the grant proposal by using appropriate language in relation to grant reviewers. In addition, the health care professional must collect, analyze, and evaluate the population’s needs and express them appropriately through the narrative portion of the grant. The federal grant writing manual delves in depth by noting parts of the proposal such as, the project narrative and the budget narrative. The chart above serves as a blueprint for the applicant to stay organized and focused during the grant writing process.
Genres for Patients
One of the main goals of this discourse community is to successfully permeate the medical information from the language of the physicians to the language of the patients. When asked about strategies for communicating with patients, Dr. David Acosta stated, “We wrote a weekly column in the newspaper we had about medicine. I also had to go on the radio and be interviewed by people about the importance of flu shots and the statistics in town” (Acosta). For services to be perceived as available, the target’s population limitations must be carefully considered when producing media to improve knowledge in the community. For instance, due to limited channels on television in rural communities, Dr. Acosta turned to the local newspaper to reach the patient population. In the weekly column titled “To Your Health”, Dr. Acosta informed the rural population about diet, exercise, flu immunizations, and diabetes. Bushy argues the importance of considering the cultural beliefs of the clients to communicate effectively. Beliefs such as the “clients’ ideas about hygiene, nutrition, exercise, when to seek professional health, how to interact with health professionals, and whether to follow medical advice” (Bushy 254). Both Dr. Acosta and Bushy respect the patient’s health beliefs to construct effective ways of communication. To inform patients about health education, Dr. Acosta used genre such as, flyers, pamphlets, and handouts. Within the genres he used for health education, Dr. Acosta had to consider the effectiveness of these genres. For example, Dr. Acosta had to consider numerous issues such as, the reading level of the patient and whether the visuals were effective. In exam rooms, Dr. Acosta made sure the patients were exposed to bullet boards with information on how to take care of themselves. Additionally, like previously stated, he would go on the radio to discuss medical topics with the community.
Genres for Physicians
Besides producing genres for the patient population, Dr. Acosta had to learn the language of the physicians. Dr. Acosta acknowledged that to assume membership within this discourse community, one needed a certain level of expertise such as a medical degree. Because it was an evidence-based-medical field, some of the older physicians in town did not have the new expertise but relied heavily on the old practice. This, in turn, created animosity between the newer doctors and the older doctors. The trained physicians constantly informed themselves through medical literature and a weekly or monthly subscription to medical journals. From the interview, I gathered that most physicians communicated through a variety of genres. In medical staff meetings, physicians discussed, over lunch, topics or issues facing the rural community. Through state meetings, doctors would compare notes and talk about malpractice coverage. According to Dr. Acosta, it was important to understand the needs of all the groups in the rural community, especially the underprivileged groups. Thus, it is imperative for physicians to serve in leadership roles through the creation of committees in hospitals.
The investigation revealed the main reason behind the success of rural health clinics is the incredible work ethic of rural health professionals. For instance, Bushy states, “[a] Psychiatric nurse is expected to function in the role of case manager for a number of clients as well as grant writer, crisis worker, administrator public relations person, and a therapist” (Bushy 258). The distinct elements that plague rural communities compared to their urban counterparts such as the “spatial distance between people and services” often are overlooked by many individuals (Bushy 260). The success of these rural clinics is attributed to the many genres utilized by this community. For services to be seen as accessible, comprehensive assessments of the target’s population needs must be taken into consideration. The client must first have access to the services and have the means to purchase the services. When producing genres, at the patient level, the physicians must consider the reading level of the patient to encourage client compliance. At the physician level, the physicians must reach a level of expertise in order to stay relevant within this community by immersing themselves in genres that will advance their medical knowledge. In addition, the physician need to communicate effectively with grant writers to obtain the aid needed to meet the demands of the population. This discourse community is a prime example of how genres play an important role in enhancing health care in rural areas.
Acosta, David. Personal Phone interview. 06 February 2017.
“Federal Grant Writing Manual.” Federal Grant Writing Manual | National Rural Health Resource Center. National Rural Health Resource Center, n.d. Web. 26 Feb. 2017.
Schmidt, Gary D., and William J. Vande Kopple. Communities of Discourse: The Rhetoric of Disciplines. Englewood Cliffs, N.J.: Prentice Hall, 1993.
Swales, John M. Genre Analysis: English in Academic and Research Settings. Cambridge [England: Cambridge University Press, 1990. Print.
William Nelson, Gili Lushkov, Andrew Pomerantz, William B. Weeks. (2006) Rural Health Care Ethics: Is _ There a Literature?. The American Journal of Bioethics 6:2, pages 44-50.