Item Details

Symptom assessment and patient resistance in primary care interactions in Chinese hospitals

Issue: Vol 2 No. 2 (2017) Special issue: Conversation analytic studies of language use in interaction

Journal: East Asian Pragmatics

Subject Areas:

DOI: 10.1558/eap.34693

Abstract:

In a study of primary care consultations in Chinese western-style medicine, two recurrent interactional patterns have been identified which are associated with making medical assessments. At various points in a consultation, the clinician may indicate that the patient’s symptoms are ‘normal’ and that nothing is medically concerning or problematic. The patient may resist that by representing her condition as being in some fashion abnormal. By contrast, when the clinician considers the patient’s symptoms as abnormal, i.e. indicating a medical abnormality and worthy of medical care (i.e. doctorable), the patient may resist by normalising her symptoms. Through analysing doctors’ symptomatic accounts and patients’ resisting talk, ‘symptom abnormality’ emerges as the central form of expression at moments in which doctors and patients are misaligned in their diagnostic reasoning.

Author: Lin Wu

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References :

Byrne, P. S., & Long, B. E. (1976). Doctors talking to patients: A study of the verbal behaviour
of general practitioners consulting in their surgeries. London: HMSO.

Clift, R. (2001). Meaning in interaction: The case of actually. Language, 77(2), 245-291.
https://doi.org/10.1353/lan.2001.0074

Collins, S., Drew, P., Watt, I., & Entwistle, V. (2005). ‘Unilateral' and ‘bilateral' practitioner
approaches in decision-making about treatment. Social Science & Medicine,
61(12), 2611-2627. https://doi.org/10.1016/j.socscimed.2005.04.047

Drew, P. (2003). Precision and exaggeration in interaction. American Sociological Review,
68(6), 917-938. https://doi.org/10.2307/1519751

Elsey, C., Drew, P., Jones, D., Blackburn, D., Wakefield, S., Harkness, K., Venneri, A. &
Reuber, M. (2015). Towards diagnostic conversational profiles of patients presenting
with dementia or functional memory disorders to memory clinics. Patient Education
& Counselling, 98(9), 1071-1077. https://doi.org/10.1016/j.pec.2015.05.021

Jefferson, G. (1984). Transcript notation. In J. M. Atkinson & J. Heritage (Eds.), Structures
of social action: Studies in conversation analysis (pp. ix-xvi). Cambridge :Cambridge
University Press.

Heath, C. (1992). The delivery and reception of diagnosis in the general practice consultation.
In J. Heritage (Ed.), Talk at work (pp. 235-267). Cambridge: Cambridge
University Press.

Heath, C. (1997). The analysis of activities in face to face interaction using video. In
D. Silverman (Ed.), Qualitative research: Theory, method and practice (pp. 183-200).
London: Sage Publication.

Heritage, J., & Robinson, J. D. (2006a). The structure of patients' presenting concerns:
Physicians' opening questions. Health Communication, 19(2), 89-102. https://doi.
org/10.1207/s15327027hc1902_1

Heritage, J., & Robinson, J. (2006b). Accounting for the visit: Giving reasons for seeking
medical care. In J. Heritage & D. Maynard (Eds.), Communication in medical care:
Interaction between primary care physicians and patients (pp. 48-85). Cambridge: Cambridge
University Press. https://doi.org/10.1017/CBO9780511607172.005

Labov, W., & Waletzky, J. (1997). Narrative analysis: Oral versions of personal experience.
Seattle: University of Washington Press.

Peräkylä, A. (1998). Authority and accountability: The delivery of diagnosis in
primary health care. Social Psychology Quarterly, 61(4), 301-320. https://doi.
org/10.2307/2787032

Peräkylä, A. (2006). Communicating and responding to diagnosis. In J. Heritage &
D. Maynard (Eds.), Communication in medical care: Interaction between primary care
physicians and patients (pp. 214-247). Cambridge: Cambridge University Press. https://
doi.org/10.1017/CBO9780511607172.010

Reuber, M., Monzoni, C., Sharrack, B., & Plug, L. (2009). Using interactional and linguistic
analysis to distinguish between epileptic and psychogenic nonepileptic seizures: A
prospective, blinded multirater study. Epilepsy & Behaviour, 16(1), 139-144. https://
doi.org/10.1016/j.yebeh.2009.07.018

Robinson, J. D. (2003). An interactional structure of medical activities during acute visits
and its implications for patients' participation. Health Communication, 15(1), 27-59.
https://doi.org/10.1207/S15327027HC1501_2

Robinson, J. D. (2006). Soliciting patients' presenting concerns. In J. Heritage &
D. Maynard (Eds.), Communication in medical care: Interaction between primary care
physicians and patients (pp. 22-47). Cambridge: Cambridge University Press. https://
doi.org/10.1017/CBO9780511607172.010

Robinson, J. D., & Heritage, J. (2005). The structure of patients' presenting concerns: The
completion relevance of current symptoms. Social Science & Medicine, 61(2), 481-493.
https://doi.org/10.1016/j.socscimed.2004.12.004

Robinson, J. D., & Heritage, J. (2006). Physicians' opening questions and patients' satisfaction.
Patient Education and Counseling, 60(3), 279-285. http://dx.doi.org/10.1016/j.
pec.2005.11.009

Tagliamonte, S., & Roberts, C. (2005). So weird; so cool; so innovative: The use of intensifiers
in the television series Friends. American Speech, 80(3), 280-300. https://doi.
org/10.1215/00031283-80-3-280