Abstract
Communication in medical care is a popular topic for research and social commentary as doctors, patients, and researchers alike work to find answers as to why patients are dissatisfied and why communication and understanding break down. A multitude of studies about medical communication is published every year (Heritage & Clayman, 2010) using a range of methodologies in an attempt to understand and remedy communication problems. However, how do we know what is good and what is bad in these interactions? To gain an understanding of what goes wrong we must first understand what actually goes on in doctor-patient consultations.
There is a paucity of research into surgeon-patient consultations in the field of health communication research. As Levinson and colleagues note, “[f]urther research is needed to study patterns of communication in surgical disciplines to form a basis for education tailored for surgical specialties” (2000, p. 1026). The need for surgeon-based communication research is apparent through its notable absence in the current doctor-patient communication body of research and there is much that can and will be done to fill this void. This research fills part of that void.
Conversation analysis has been successfully used in the analysis of primary care communication research (Heritage & Maynard, 2006b). In this research, I have used what is known about the “generic orders of organization” (Schegloff, 2007, p. xiv) of conversation to analyse the turn-taking, sequence organization and turn design of 35 video-recorded surgeon-patient consultations. This research comes under the auspices of the Applied Research on Communication in Health (ARCH) group at the University of Otago, Wellington, New Zealand. ARCH researches health care communication using a variety of methodologies. All of the data was recorded in New Zealand. Of the 35 video-recorded consultations, 18 were collected in November and December 2006 and also included patient and surgeon survey data. The other 17 come from a data corpus collected in 2004. The data includes 21 general surgery consultations, while the other 14 consultations come from orthopaedics, vascular surgery, breast cancer surgery and cardiothoracic surgery.
Heritage and Maynard (2006c, p. 15) argue that “investigating the overall structural organization of a medical visit… is valuable in providing access to understandings about the nature of the medical visit which are drawn upon by physicians and patients in their joint management of its progress”. After an examination of the literature and description of the methods and data, I focus on the activities being oriented to and performed by the participants as well as the overall structural organisation of the consultation. The first analytical chapter, chapter 4, is intended to provide an overview of how the institutional goals of the surgeon-patient consultation are achieved over the course of the interaction. The six activities of first and checkup surgeon-patient visits are interdependent and form an overall project designed to achieve the institutional goals of remedying the patient’s presenting problem. Each of these activities is explored in subsequent chapters. Activity 1, establishing mutual understanding of the referral and achieving alignment, and Activity 2, establishing the patient’s description (and perspective) of their problem, are analysed in chapter 5. Activity 3, gathering further information through verbal and/or physical examination, is examined in chapter 6, Activity 4, reformulating the problem, in chapter 7, Activity 5, proposing next steps, in chapter 8 and Activity 6, closing the consultation, in chapter 9. In each of these analyses, not only are the structures of the activities described, but also how patients have agency within their interactional constraints.