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" On structures in medical interactions : "
Campion, Peter David.
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Latin Dissertation
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| Record Number
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1095212
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| Doc. No
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TLets387372
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| Main Entry
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Campion, Peter David.
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| Title & Author
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On structures in medical interactions :\ Campion, Peter David.
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| College
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University of Liverpool
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| Date
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1994
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| student score
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1994
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| Degree
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Ph.D.
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| Abstract
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This thesis addresses from within the research paradigm of Conversation Analysis (CA)the question "How are interactions between patients and general practitionersorganised? ". CA is a relatively recent tradition within the "interpretative paradigm" ofsociology, growing out of the ethnomethodology of Garfinkel. The thesis first reviewsthe relevant literature of CA and medical interactions, and critically discusses themethodology.The empirical analysis used naturally occurring consultations in British general practice,video-recorded in five practices, involving 14 doctors, and about 50 hours of recording,made between 1987 and 1992. Recordings were observed first in an unmotivated way, tonote occurrences of interesting interactional phenomena. Objects for further study werecopied onto secondary "collection" tapes, which were then examined in depth, andtranscribed in detail using conventions developed within CA.The analyses described here are: the use of time in the consultation; the impact ofmedical records on the interaction; prescribing and associated talk; the phenomenon of"facilitation", how doctors appear to enable patients to talk; patient-initiated questions,and rejection of patients' ideas by doctors; and finally the use of the word "we". The aimwas to describe and explore, but not necessarily to explain, although in describing themechanism of interaction in these areas of activity, empirical evidence is advanced forparticular explanations.The phenomenon of patients raising new topics at the end of consultations is described,with its interactional implications: the "by-the-way" phenomenon is explored anddocumented. Case-notes are seen to contribute to consultations in a complex way, andlike talk, are both context-dependent and context-forming. Utterances such as "right","uhuh", "mmhm" which appear on the face of it to be facilitatory, can be the reverse.The phenomenon of dispreference for disagreements by patients is re-examined, andcontexts in which patients do disagree are explored. Doctors' rejections of patients' ideasare described, and implications for teaching about the consultation are drawn. Finallythe various ways in which the word "we" is used by doctors are described and criticallyappraised, in the context of a philosophical understanding of "intersubjectivity".The study adds to the body of transcribed interactions drawn from general practice, andsheds some light on ways in which general practitioners and patients structure theirconsultations. It has implications for the way medical students learn how to consult, andfor how research on the consultation can be conducted. Conversation analysis is shownto be a powerful qualitative analytic methodology, relevant to the study of medicalinteractions.
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| Subject
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Health services community care services
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| Added Entry
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University of Liverpool
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