Communication in Medical Care: Interaction between Primary Care Physicians and Patients (Studies in Interactional Sociolinguistics, Series Number 20)

This 2006 volume provides a comprehensive discussion of communication between doctors and patients in primary care consultations. It brings together a team of leading contributors from the fields of linguistics, sociology and medicine to describe each phase of the primary care consultation, identifying the distinctive tasks, goals and activities that make up each phase of primary care as social interaction. Using conversation analysis techniques, the authors analyze the sequential unfolding of a visit, and describe the dilemmas and conflicts faced by physicians and patients as they work through each of these activities. The result is a view of the medical encounter that takes the perspective of both physicians and patients in a way that is both rigorous and humane. Clear and comprehensive, this book will be essential reading for students and researchers in sociolinguistics, communication studies, sociology, and medicine. Half-title......Page 3 Series-title......Page 4 Title......Page 5 Copyright......Page 6 Contents......Page 7 Figures......Page 9 Tables......Page 10 Contributors......Page 11 Foreword......Page 13 Temporal and sequential relationships......Page 16 Aspects of speech delivery, including aspects of intonation......Page 18 Other markings......Page 20 1 Introduction: Analyzing interaction between doctors and patients in primary care encounters......Page 23 Process analysis......Page 24 Microanalysis......Page 26 Taking stock......Page 28 (1) Conversation analysis: a brief introduction......Page 31 The primary care interview: levels of analysis......Page 35 Overall structural organization......Page 36 Sequence organization......Page 37 Turn design......Page 39 Conclusion......Page 41 2 Soliciting patients’ presenting concerns......Page 44 Data......Page 46 Question formats designed to solicit new concerns......Page 47 How are you feeling?......Page 51 Quantitative results for follow-up-concern question formats......Page 57 Question formats designed to index chronic-routine visits......Page 58 Question formats that do not index patients’ institutionally relevant concerns......Page 61 Question formats that are inappropriately fitted to patients’ concerns......Page 63 Discussion......Page 67 Introduction......Page 70 Presenting a concern: initial considerations......Page 72 Routine acute problems......Page 73 Recurrent problems......Page 74 Unknown medical problems......Page 76 Accounting for the visit: the problem of legitimate doctorability......Page 79 Practices for justifying medical visits......Page 87 Making diagnostic claims......Page 88 Invoking third parties......Page 93 Troubles resistance......Page 96 Troubles resistance in “routine acute” medical problems......Page 98 Troubles resistance in “unknown” medical problems......Page 100 Concluding remarks......Page 105 Introduction......Page 108 The “patients’ problem”......Page 110 Teach us to care and not to care: the “balance of involvement and detachment”......Page 112 Establishing the “reason for visit” vs. “taking a history”......Page 115 “At first I thought ‘X’”......Page 119 A “sequence of noticings”......Page 122 Doing things with stories: uses of the narratives......Page 124 Conclusion: a social epistemics of sensation......Page 132 Problem-discovery narratives as patients’ models in situ......Page 134 Clinical implications: working at being a reasonable patient......Page 135 Introduction......Page 137 Design of patients’ explanations for health problems......Page 139 Overt explanations......Page 140 Tacit explanations......Page 142 Explanation design and placement......Page 145 Explanations that strongly compel doctors’ confirming or disconfirming assessments......Page 148 Doctors’ immediate disconfirming assessments......Page 150 Doctors’ immediate confirming assessments......Page 152 Explanation–query sequences......Page 154 Query focuses on the patient’s symptom, no assessment occurs......Page 157 Query focuses on the causal factor, no assessment occurs......Page 159 Query focuses on the patient’s symptom, assessment occurs after a delay......Page 162 Query focuses on evidence the patient provides, assessment occurs after a delay......Page 165 Conclusion......Page 168 Introduction......Page 173 The data......Page 175 Question design: some basic preliminaries......Page 176 Medical questioning sets agendas......Page 177 Medical questioning embodies presuppositions......Page 181 Medical questioning can “prefer” particular responses......Page 182 Two principles of routine medical questioning......Page 185 The principle of optimization......Page 186 The principle of recipient design......Page 188 Medical history-taking: constructing routines and contingencies......Page 190 Handling contingencies......Page 193 Optimization and recipient design: clashes and resolutions......Page 196 “Alcohol use?”: an excursion into lifestyle......Page 200 Discussion......Page 204 Introduction......Page 207 Constituting the body as an object......Page 211 Configuring the site......Page 217 Revealing symptoms......Page 227 Discussion: patient participation and professional assessment......Page 230 Introduction......Page 236 Earlier research on diagnosis......Page 237 Data for the study......Page 238 How the doctors tell the patient about the diagnosis......Page 239 Three types of diagnostic utterance......Page 240 Presence of evidence in plain assertions......Page 244 Departures from the default pattern......Page 246 Problems arising from extended inferential distance......Page 247 Problems arising from challenges to medical expertise......Page 250 The patients’ responses to the doctors’ diagnostic utterances......Page 255 When do the patients talk after hearing the diagnosis?......Page 256 Patient displaying agreement......Page 260 Patients resisting the doctors’ diagnosis......Page 261 Responses to diagnosis: a summary......Page 266 Conclusion......Page 268 9 On diagnostic rationality: bad news, good news, and the symptom residue......Page 270 Diagnostic news deliveries in primary care......Page 272 Asymmetries between good and bad news: minor conditions......Page 274 Cardiovascular good news......Page 278 Cancer bad news......Page 282 Comparing good and bad news in primary care......Page 288 Good news, indeterminacy, and uncertainty: the problem of symptom residue......Page 293 Conclusion......Page 298 10 Treatment decisions: negotiations between doctors and parents in acute care encounters......Page 301 Patient participation in health care......Page 302 Responses to diagnosis deliveries and treatment recommendations......Page 303 Withholding acceptance as passive resistance......Page 305 Active resistance......Page 310 The format of treatment recommendation......Page 322 Parent responses to alternative treatment recommendation formats......Page 325 Treatment recommendation formats: implications for health care practitioners......Page 331 Discussion......Page 332 Introduction......Page 335 The computer system......Page 337 Communicating prescription-related information that corresponds to details entered into the computer fields......Page 340 Communicating prescription-related information which does not correspond to details entered into the computer fields......Page 345 Patients’ responses......Page 350 The patients’ bodily movements as they ask questions......Page 354 The patients’ bodily movements during the doctors’ responses......Page 355 Discussion......Page 357 Earlier research......Page 362 Data......Page 364 Questions that are asked subsequent to a formulation of a medical problem......Page 365 Questions that are asked further away from the formulation of the medical problem......Page 367 Types of no-problem answer......Page 369 Reception of no-problem answers......Page 372 Exits from the discussions on a lifestyle issue in no-problem cases......Page 375 Establishing lifestyle as problematic......Page 377 Overt problem orientation......Page 378 Consolidating an incipient problem orientation......Page 380 Incipient problem orientation that is not consolidated......Page 386 Advice on lifestyle......Page 388 Advice that is sequentially “next” after the history-taking......Page 391 Advice with no preceding interview......Page 393 Invoking the problem orientation through advice......Page 395 Summary and conclusion......Page 398 Introduction......Page 401 Empirical studies of closings in primary care visits......Page 403 Closings in conversation......Page 405 Bounding off and shutting down conversational topics......Page 407 Announcing closure......Page 409 Termination......Page 411 Preclosing......Page 414 Preparing for preclosing......Page 420 Responding to preclosing initiations......Page 423 “By the way ...”......Page 427 Managing termination and producing continuity of care......Page 431 Closing......Page 436 Introduction: after-hours calls as a form of telephone medicine......Page 438 The doctor’s decision about whether to make home visits, in response to after-hours calls......Page 441 A misalignment between caller and doctor......Page 445 Callers pursue dramatic detailing of patients’ symptoms......Page 447 Caller and doctor display a different assessment of the significance of certain diagnostic signs or symptoms......Page 454 Callers’ diagnostic hypotheses......Page 459 Conclusion......Page 465 References......Page 467 Subject index......Page 503 Name index......Page 506 Providing A Comprehensive Discussion Of Communication Between Doctors And Patients In Primary Care Consultations, This Volume Brings Together A Team Of Leading Contributors From The Fields Of Linguistics, Sociology And Medicine To Describe Each Phase Of The Primary Care Consultation. The Authors Use Conversation Analysis Techniques To Analyze The Sequential Unfolding Of A Visit And Describe The Dilemmas And Conflicts Faced By Physicians And Patients As They Work Through The Visit. The Result Is A View Of The Medical Encounter That Reveals The Perspective Of Both Physicians And Patients Rationally. . Analyzing Interaction Between Doctors And Patients In Primary Care Encounters / John Heritage And Douglas W. Maynard -- Soliciting Patients' Presenting Concerns / Jeffrey D. Robinson -- Accounting For The Visit: Giving Reasons For Seeking Medical Care / John Heritage And Jeffrey D. Robinson -- Realizing The Illness: Patients' Narratives Of Symptom Discovery / Timothy Halkowski -- Explaining Illness: Patients' Proposals And Physicians' Responses / Virginia Teas Gill And Douglas W. Maynard -- Taking The History: Questioning During Comprehensive History-taking / Elizabeth Boyd And John Heritage. Body Work: The Collaborative Production Of The Clinical Object / Christian Heath -- Communicating And Responding To Diagnosis / Anssi Per̈akyla -- On Diagnostic Rationality: Bad News, Good News, And The Symptom Residue / Douglas W. Maynard And Richard M. Frankel -- Treatment Decisions: Negotiations Between Doctors And Patients In Acute Care Encounters / Tanya Stivers -- Prescriptions And Prescribing: Coordinating Talk- And Text Based Activities / David Greatbatch -- Lifestyle Discussions In Medical Interviews / Marja-leena Sorjonen ... [et Al.] -- Coordinating Closings In Primary Care Visits: Producing Continuity Of Care / Candace West. Misalignments In 'after-hours' Calls To A British Gp's Practice: A Study In Telephone Medicine / Paul Drew. Edited By John Heritage And Douglas W. Maynard. Includes Bibliographical References (p. [445]-480) And Indexes. Introduction: analyzing interaction between doctors and patients in primary care / John Heritage and Douglas W. Maynard Soliciting patients' presenting concerns / Jeffrey Robinson Accounting for the visit : giving reasons for seeking medical care John Heritage and Jeffrey Robinson Realizing the illness : patients' narratives of symptom discovery Tim Halkowski Explaining illness: patients' proposals and physicians' responses Virginia Gill and Douglas W. Maynard Taking the history : questioning during comprehensive history Taking / Elizabeth Boyd and John Heritage Body work : the collaborative production of the clinical object Christian Heath Communicating and responding to diagnosis / Anssi Perakyla On diagnostic rationality: bad news, good news, and the Symptom residue / Douglas W. Maynard and Richard M. Frankel Treatment decisions : negotiations between doctors and patients in acute care encounters / Tanya Stivers Prescriptions and prescribing : co-ordinating talk and text based Activities Lifestyle discussions in medical interviews / Marja-Leena Sorjonen Coordinating closings in medical interviews: producing continuity of care / Candace West Mis-alignments in 'after-hours' calls to a family doctor's practice: A study in telephone medicine / Paul Drew References Subject index Name index. This new and pathbreaking volume provides a comprehensive discussion of communication between doctors and patients in primary care consultations. The first of its kind for thirty years, it brings together a team of leading contributors from the fields of linguistics, sociology and medicine to describe each phase of the primary care consultation, identifying the distinctive tasks, goals and activities that make up each phase of primary care as social interaction. Using conversation analysis techniques, the authors analyze the sequential unfolding of a visit, and describe the dilemmas and conflicts faced by physicians and patients as they work through each of these activities. (Midwest) In this new and pathbreaking volume, a team of leading contributors from the fields of linguistics, sociology and medicine examine how doctors and patients communicate in primary care consultations. Clear, informative and comprehensive, it will be essential reading for students and researchers in sociolinguistics, communication studies, sociology, and medicine In this 2006 volume, a team of leading contributors from the fields of linguistics, sociology and medicine examine how doctors and patients communicate in primary care consultations. Clear, informative and comprehensive, it will be essential reading for students and researchers in sociolinguistics, communication studies, sociology, and medicine.