Reducing asymmetry in doctor-patient interaction: patients' initiatives in specialised clinical encounters (original) (raw)
Related papers
2000
1. INTRODUCTION 1.1. Social interaction as a primary focus of social psychological research 1.2. Doctor-patient interaction as a topic of study 1.2.1. Empirical study on doctor-patient interaction 1.3. Motivation for the study 1.4. Conversation analysis 1.4.1. Some basic structures of ordinary conversation 1.4.2. Institutional interaction 1.5. Conversation analytic view on control 1.6. Data and method 1.6.1. CA approach to the data 1.6.2. Research process 1.7. The structure of the study 2. THE ROLE AND POSITION OF PROBLEM PRESENTATION IN MEDICAL CONSULTATION 2.1. The overall structure of the consultation 2.2. The importance of the phase of problem presentation 2.3. The structure of the phase of problem presentation 3. THE OPENING QUESTION ANDHOW THE PATIENTS BEGIN THEIR COMPLAINTS 3.1. The position of the opening question in the overall structure of the consultation and major dimensions of the analysis 3.2. Closed-ended questions-minimal answers? 3.2.1. Minimal answers to closed-ended yes/no questions 65 3.2.2. Expanding the focus 3.2.3. Correcting the focus 3.2.4. Discussion 3.3. Open-ended questions-answering the question or delivering the complaint? 3.3.1. Fitting the design of the answer to the design of the doctor's question 3.3.2. Designing answers as responses to a suggestion to start the medical business 3.3.3. Treating doctors' ambiguous turns as opening questions 3.3.4. Starting without the doctor's opening question 3.3.5. Discussion 3.4. Conclusion 4. PATIENTS' PROBLEM PRESENTATIONS: GETTING THE FLOOR AND KEEPING IT, ESTABLISHING THE VIEWPOINT 4.1. Variation in complaint design 4.2. Controlling the space available for presenting the problem 4.2.1. Temporally fitted minimal answers 4.2.2. Narrativized complaints 4.3. Different orientations in different designs 4.3.1. Narrative design: finding the balance between 'an ordinary patient' and 'a particular problem' 4.3.2. Narratives presenting uncured problems: focusing on compliance as an aspect of the patient role 4.3.3. Non-narrativized complaints: patient role is not made relevant 143 4.4. Conclusion 5. HEADING TOWARDS UPTAKE: CHARACTERISTICS OF THE ELEMENTS PLACED AS LAST IN PROBLEM PRESENTATION 5.1. Providing availability for the recipient 5.1.1. Stepping into the doctor's territory 5.1.1.1. Overtly addressing the doctor' expertise: asking questions from the doctor 5.1.1.2. Making diagnostic suggestions 5.1.1.3. Using medical terms or describing medical procedures 5.1.2. Availability by pointing (invoking a common focus of interest in situ) 5.1.3. Availability by invoking a common everyday activity 5.2. Detailing 5.3. Escalating the complaint 5.4. Conclusion 6. RECEIVING THE PROBLEM PRESENTATIONS: DIFFERENT WAYS OF CONTROLLING THE COURSE OF CONSULTATION 6.1. Placement and 'type' of doctors' next turns with regard to problem presentation 6.1.1. Next turns preserving the recipient position 6.1.2. Next turns suggesting a shift in conversational roles 6.1.3. Collaborative completions 6.1.4. Interruptions 6.2. Different styles of suggesting a shift forward-different 'degrees' of control 6.2.1. Bounding off-negotiating the shift 6.2.2. Unilateral shift-shading the topic 6.2.3. Unilateral control of the shift-changing the topic 6.3. Conclusion 7. GAZE AND POSTURE AS WAYS OF CONTROLLING THE COURSE OF PROBLEM PRESENTATION 7.1. Engagement in doctor-patient interaction 7.1.1. Gaze and engagement in conversation 7.1.2. Postural orientation 7.1.3. Monitoring of the doctors' movements by the patients 7.2. Quantitative observations on the interrelatedness of disengagements and dysfluencies 7.3. Looking means listening-four environments in which displays of engagement are essential 7.3.1. Disengagement with home position away from the patient 7.3.2. Disengagement with manifest shift in orientation 7.3.3. Disengagement at critical point in description 7.3.4. Disengagement at critical point of story-telling 7.4. Conclusion 8. CONCLUSION 8.1. 'Request for service-response' as the activity context of the whole consultation 8.1.1. Immediate sequential context vs. activity context of the whole consultation 8.1.2. Morality inherent in conversation vs. morality specific to institutional and/or medical interaction 8.1.3. Multiple levels of context and constituents of 'good interaction' 8.2. Control in the medical consultation 280 8.2.1. Participants' means for control 8.2.2. Some implications for study of control in the medical consultation 8.3. On generalizability and CA
Studies of doctor-patient interaction
Annual Review of Public Health, 1989
Discussion between doctors and patients has long been regarded as the vehicle by which much of the curing and caring of medicine is conveyed. Sometimes regarded as the art or heart of medicine, its importance was well noted in antiquity and is recognized in modem times. However, it is only since the mid-1960s that the actual dynamics of the therapeutic dialogue have been observed in any systematic manner and that an attempt to recast this aspect of medicine as science has been made. The evolution of methodological and technological sophistication has made observation and analysis of the medical visit easier over the years, and, indeed, the number of empirical studies of doctor-patient communication doubled between 1982 and 1987 to over 60 (47). Several reviews of this body of work have been undertaken (28, 39, 51,55, 57), but a resulting synthesis has been lacking; this is a difficult body of work to review. The predominantly exploratory nature of this research, which is largely of the kind in which everything gets correlated with everything else (24), contributes to an overwhelming number of results with which to contend. The results appear so confusing that Inui & Carter (28), in reviewing this literature, characterized the findings as a "Rorschach test" for readers in which overall interpretations are as apt to reveal something about the reader as about the results themselves. We have elected, therefore, to supplement a selective review of the litera
Introduction: Analyzing interaction between doctors and patients in primary care encounters
STUDIES IN INTERACTIONAL SOCIOLINGUISTICS, 2006
In 1976, Patrick Byrne and Barrie Long published a path-breaking study of the doctor-patient relationship. Based on some 2,500 taperecorded primary care encounters, Doctors Talking to Patients anatomized the medical visit into a series of stages, and developed an elaborate characterization of doctor behaviors in each of them. Drawing on Michael Balint's (1957) proposal that the primary care visit has therapeutic value in its own right, Byrne and Long focused on the ways in which its therapeutic possibilities were attenuated by the prevalence of doctor-centered behaviors in the encounters they studied. The study was also conceived as an intervention: physicians were invited to use its coding framework to evaluate their own conduct, and to modify it in a more patient-centered direction. Not surprisingly, given these goals, Doctors Talking to Patients was itself somewhat doctor-centered. The authors had little to say about patients' contributions to the encounter or the sociocultural context of social interaction in primary care. In the present volume we revisit Byrne and Long's project of anatomizing the primary care visit, doing so from a primarily sociological and interactional perspective. We begin from the standpoint that physician and patient-with various levels of mutual understanding, conflict, cooperation, authority, and subordination-jointly construct the medical visit as a real-time interactional product. Within this orientation, we consider some of the social, moral, and technical dilemmas that physicians and patients face in primary care, and the resources that they deploy in solving them. Our objective is to open the study of doctor-patient relations to a wide range of social and interactional considerations.
Communication & Medicine, 2018
This paper aims to describe the interactional processes through which a medical professional and a patient collaboratively accomplish filling out answers to a questionnaire. Empirical analysis of three different sequences from a video-recorded doctor-patient interaction in which questions of a questionnaire were answered with a ‘no' reveals three different ways (or methods) in which doctor and patient accomplish this jointly. Applying ethnomethodological conversation analysis (EMCA) as our methodological framework, we conclude that the three interactional practices are fitted in relation to the constraints of the interview that is itself methodically aligned to the practices and organizational structures of the institution, a Danish hospital. Furthermore, we make the case that questionnaires are designed as idealizations of question-answer sequences, and as such do not operate at the same level of detail as the actual question-answer situation. Details that are crucial for the o...
Interrogative Strategies of Doctor - Patient Communication
International Journal of Communication Research, 2013
1. STRUCTURAL ELEMENTS OF DOCTOR - PATIENT COMMUNICATION AND APPLIED MODELS IN HEALTH COMMUNICATIONRegarded from the perspective of the doctor, the doctor - patient communication aims to clarify the diagnosis. To arrive at a more accurate diagnosis as a proper treatment of the patient's positive response (Treatment compliance), analyzes and laboratory investigations are not only enough, but also the way in which the doctor has the ability to directly communicate with the patient and maintain the communication relationship. The doctor, even from the very first meeting with his patient is placed in a position to discuss how patient develops his/her professional activity, personal life, to describe his condition, his problems facing the suffering that accuses. For this reason, but not only for this, the doctor-patient communication doesn't have a rigid, fixed form, but it changes during the process of communication. Specialists, especially psychologists, draw attention to the c...
Patient Education and Counseling, 2009
An increasing number of consultations are delivered in group practices, where a stable 1:1 relationship between patient and physician cannot be guaranteed. Therefore, correct documentation of the content of a consultation is crucial to hand over information from one health care professional to the next. We randomly selected 20 interviews from a series of 56 videotaped consultations with patients requesting a general check-up exam in the outpatient department of Internal Medicine at the University Hospital Basel. All patients actively denied having any symptoms or specific health concerns at the time they made their appointment. Videotapes were analysed with the Roter Interaction Analysis System (RIAS). Corresponding physician notes were analysed with a category check-list that contained the information related items from RIAS. Interviews contained a total of 9.002 utterances and lasted between 15 and 53min (mean duration: 37min). Patient-centred communication (Waiting, Echoing, Mirroring, Summarising) in the videos significantly correlated with the amount of information presented by patients: medical information (r=.57; p=.009), therapeutic information (r=.50; p=.03), psychosocial information (r=.41; p=.07), life style information (r=.52; p=.02), and with the sum of patient information (r=.64; p=.003). Even though there was a significant correlation between the amount of information from the video and information in physician's notes in some categories (patient gives medical information; Pearson's r=.45; p=.05, patient gives psychosocial information; Pearson's r=.49; p=.03), an inspection of the regression lines shows that a large extent of patient information is omitted from the charts. Physicians never discussed with patients whether information should be documented in the charts or omitted. The use of typical patient-centred techniques increases information gathered from patients. Physicians document only a small percentage of patient information in the charts, their 'condensing heuristic' is not shared with patients. Patient involvement should be advocated not only to medical decision making but also to the way physicians document the content of a consultation. It is a joint responsibility of patient and health care professional to decide, which information should be kept and thus be communicated to another health care professional in future consultations.