Reviewed by Sarah May Fauzi, The University of Texas at Arlington
Bringing together medical discourse linguists and nonlinguists, this book uses conversation analysis to discuss interactions between patients and their primary care physicians. A forward by Debra Roter explains some of the changes in the way medical discourse has been analyzed; she stresses the importance of incorporating both quantitative and qualitative analysis. Many of the authors use mixed methods to reach their conclusions, which adds clarity to the findings and implications.
The introduction, ‘Analyzing interaction between doctors and patients in primary care encounters’, explains how conversation analysis can be used to understand and improve medical communication. The following thirteen chapters seem to fall into four themes: Symptom taking, exam and diagnosis, treatment and closings, and telephone medicine.
The chapters on symptom and history taking provide an analysis of how and when patients choose to present their complaints to a physician as well as insight into patients’ complaints or lists of symptoms that often justify their decision to visit a physician. The patient will often provide evidence such as third party accounts to explain how the illness was severe enough to warrant the office visit. This section ends with a chapter (Ch. 6) that establishes the dimensions of questioning and answering during history taking to address the agendas, presuppositions, and preferences of the participants.
The chapters about examination and diagnosis include an investigation of the body as an instrument of language during the physical examination. Ch. 7 analyzes physical movements such as turns of the head and eyes as means of communicating with the physician during the exam. Ch. 8 explains the patient’s opinions and presuppositions about the diagnosis as well as the physician’s response to such opinions. Finally, Ch. 9 discusses the delivery of different kinds of news to the patient.
Four chapters explore medical interview treatments and closings; specifically how patients and physicians negotiate treatment plans and prescriptions. Perhaps the most disappointing chapter is Ch. 11, ‘Prescription and prescribing: Coordinating talk- and text-based activities’. Although this chapter attempts to address the complications of using a computer in the exam room to enter information and type prescriptions, it fails to fully investigate the effect of computers on interaction within the room. It is a fascinating area and a new problem that technology has bestowed upon us, but its effects are yet to be fully explored. Ch. 12 provides an interesting look into lifestyle discussions between the physician and patient that occur after diagnosis. Ch. 13 examines the closings of the medical interview and ends appropriately with the closing of a door.
The final chapter observes physicians’ negotiation with patients (mainly parents of pediatric patients) and the decision of whether or not to visit the home based on the information given over the phone. Communication in medical care brings much needed addition to the field of medical discourse.