‘Shift’ ‘n ‘control’: The computer as a third interactant in Spanish-language medical consultations
Keywords:computer, discourse analysis, language, medical, narrative, Spanish
AbstractThe purpose of this paper is to examine the role of the computer in medical consultations in which EnglishSpanish-bilingual medical providers interact with Spanish-monolingual patients. Following previous studies that have revealed that the presence of the computer in consultations detracts from direct provider–patient communication, we pay specific attention to how the use of the computer in Spanishlanguage medical consultations can complement or adversely affect the co-construction of the patient’s health narrative. The data for the present study consist of 36 Spanish-language medical consultations in Southern California. Applying a conversation analytical approach to the health narratives in the corpus, we argue that the computer is essentially a third interactant to which medical providers orient through lowered volume, minimal responses, bureaucratic side talk, and, most importantly, codeswitching to English – all of which strip the patients of control over the co-construction of their health narrative with their medical provider. Because the patient does not have access to the computational task and the language, we posit that this exacerbates the already existing adverse effects that the computer has on provider–patient interaction.
Als, A. B. (1997) The desk-top computer as a magic box: Patterns of behavior connected with the desk-top computer; GPs’ and patients’ perceptions. Family Practice 14 (1): 17–23. http://dx.doi.org/10.1093/fampra/14.1.17
Assis-Hassid, S., Reychav, I., Heart, T., Pliskin, J. S. and Reis, S. (2015) Enhancing patient-doctor-computer communication in primary care: Towards measurement construction. Israel Journal of Health Policy Research 4 (4). http://dx.doi.org/10.1186/2045-4015-4-4
Beach, W. A. and Dixon, C. N. (2001) Revealing moments: Formulating understandings of adverse experiences in a health appraisal interview. Social Science Medicine 52 (1): 25–44. http://dx.doi.org/10.1016/S0277-9536(00)00118-0
Booth, N., Robinson, P. and Kohannejad, J. (2004) Identification of high-quality consultation practice in primary care: The effects of computer use on doctor-patient rapport. Informatics in Primary Care 12 (2): 75–83. http://dx.doi.org/10.14236/jhi.v12i2.111
Costello, B. A. and Roberts, F. (2001) Medical recommendations as joint social practice. Health Communication 13 (3): 241–260. http://dx.doi.org/10.1207/S15327027HC1303_2
Cuffe, S. P., Waller, J. L. and Cuccaro, M. L. (1995) Race and gender differences in the treatment of psychiatric disorders in young adolescents. Journal of the American Academy of Child and Adolescent Psychiatry 34 (11): 1536–1543. http://dx.doi.org/10.1097/00004583-199511000-00021
Drew, P. and Heritage, J. (1992) Analyzing talk at work: An introduction. In P. Drew and J. Heritage (eds) Talk at Work, 3–65. Cambridge: Cambridge University Press.
Fisher, S. (1983) Doctor talk / patient talk: How treatment decisions are negotiated in doctor-patient communication. In S. Fisher and A. D. Todd (eds) The Social Organization of Doctor-Patient Communication, 135–157. Washington, DC: Center for Applied Linguistics.
Fisher, S. (1995) Nursing Wounds: Nurse Practitioners, Doctors, Women Patients, and the Negotiation of Meaning. New Brunswick, NJ: Rutgers University Press.
Frankel, R. M. (2001) Cracking the code: Theory and method in clinical communication analysis. Health Communication 13 (1): 101–110. http://dx.doi.org/10.1207/S15327027HC1301_09
Garrison, G. M., Bernard, M. E. and Rasmussen, N. H. (2002) 21st-Century health care: The effect of computer use by physicians on patient satisfaction at a family medicine clinic. Family Medicine 34 (5): 362–368.
Goffman, E. (1981) Forms of Talk. Philadelphia: University of Pennsylvania.
Goffman, E. (1983) The interaction order. American Sociological Review 48 (1): 1–17. http://dx.doi.org/10.2307/2095141
Goodwin, C. (1986) Between and within: Alternative sequential treatments of continuers and assessments. Human Studies 9 (2): 205–217. http://dx.doi.org/10.1007/BF00148127
Goodwin, C. and Heritage, J. (1990) Conversation analysis. Annual Review of Anthropology 19 (1): 283–307. http://dx.doi.org/10.1146/annurev.an.19.100190.001435
Greatbatch, D., Heath, C., Campion, P. and Luff, P. (1995) How do desk-top computers affect the doctor-patient interaction? Family Practice 12 (1): 32–36. http://dx.doi.org/10.1093/fampra/12.1.32
Greatbatch, D., Heath, C. and Luff, P. (1993) Interpersonal communication and human-computer interaction: An examination of the use of computers in medical consultations. Interacting with Computers 5 (2): 193–216. http://dx.doi.org/10.1016/0953-5438(93)90018-O
Heath, C. (1992) The delivery and diagnosis in the general practice consultation. In P. Drew and J. Heritage (eds) Talk and Work: Interaction in Institutional Settings, 235–267. Cambridge: Cambridge University Press.
Heritage, J. and Lindstrom, A. (1998) Motherhood, medicine and morality: Scenes from a medical encounter. Research on Language and Social Interaction 31 (3–4): 397–438. http://dx.doi.org/10.1080/08351813.1998.9683598
Heritage, J. and Maynard, D. W. (2006) Communication in Medical Care: Interaction between Primary Care Physicians and Patients. Cambridge: Cambridge University Press. http://dx.doi.org/10.1017/CBO9780511607172
Hsu, J., Huang, J., Fung, V., Robertson, N., Jimson, H. and Frankel, R. (2005) Health information technology and physician-patient interactions: Impact of computers on communication during outpatient primary care visits. Journal of the American Medical Informatics Association 12 (4): 474–480. http://dx.doi.org/10.1197/jamia.M1741
Hutchby, I. and O’Reilly, M. (2010) Children’s participation and familial moral order in family therapy. Discourse Studies 12 (1): 49–64. http://dx.doi.org/10.1177/1461445609357406
Jefferson, G. (2002) Is ‘no’ an acknowledgement token? Comparing American and British (+) (-) tokens. Journal of Pragmatics 34: 1345–1383. http://dx.doi.org/10.1016/S0378-2166(02)00067-X
Likourezos, A., Chalfin D. B., Murphy D. G., Sommer, B., Darcy, K. and Davidson, S. J. (2004) Physician and nurse satisfaction with an electronic medical record system. Journal of Emergency Medicine 27 (4): 419–424. http://dx.doi.org/10.1016/j.jemermed.2004.03.019
Margalit, R. S., Roter, D., Dunevant, M. A., Larson, S. and Reis, S. (2006) Electronic medical record use and physician-patient communication: An observational study of Israeli primary care encounters. Patient Education and Counseling 61 (1): 134–141. http://dx.doi.org/10.1016/j.pec.2005.03.004
Maynard, D. W. (1989) Notes on the delivery and reception of diagnostic news regarding mental possibilities. In D. Helm, T. Anderson, A. J. Meehan and A. Rawls (eds) Interactional Order: New Directions in the Study of Social Order, 54–67. New York: Irvington Press.
Maynard, D. W. (1991) Interaction and asymmetry in clinical discourse. American Journal of Sociology 97 (2): 448–495. http://dx.doi.org/10.1086/229785
Maynard, D. W. (2004) On predicting a diagnosis as an attribute of a person. Discourse Studies 6 (1): 53–76. http://dx.doi.org/10.1177/1461445604039439
Maynard, D. W. and Frankel, R. M. (2006) On the edge of rationality in primary care medicine: Bad news, good news, and uncertainty. In J. Heritage and D. W. Maynard (eds) Communication in Medical Care: Communication between Primary Care Physicians and Patients. Cambridge: Cambridge University Press.
Mondada, L. (2003) Working with video: How surgeons produce video records of their actions. Visual Studies 18 (1): 58–73. http://dx.doi.org/10.1080/1472586032000100083
Noordman, J., Verhaak, P., van Beljouw, I. and van Dulmen, S. (2010) Consulting room computers and their effect on general practitioner-patient communication. Family Practice 27 (6): 644–651. http://dx.doi.org/10.1093/fampra/cmq058
Ochs, E. (1997) Narrative. In T. A. Van Dijk (ed.) Discourse as Structure and Process, 185–207. London: Sage.
Ochs, E. and Capps, L. (1997) Narrating lives in the balance. In Salsa V: Proceedings of Symposium about Language and Society, 1–16. Austin: University of Texas.
Pearce, C., Arnold, M., Phillips, C., Trumble, S. and Dwan, K. (2011) The patient and the computer in the primary care consultation. Journal of the American Informatics Association 18 (2): 138–142. http://dx.doi.org/10.1136/jamia.2010.006486
Peräkylä, A. (1998) Authority and accountability: The delivery of diagnosis in primary health care. Social Psychology Quarterly 61 (4): 301–320. http://dx.doi.org/10.2307/2787032
Peräkylä, A. (2002) Agency and authority: Extended responses to diagnostic statements in primary care encounters. Research on Language and Social Interaction 35 (2): 219–247. http://dx.doi.org/10.1207/S15327973RLSI3502_5
Pomerantz, A. and Rintel, S. (2004) Practices for reporting and responding to test results during medical consultations: Enacting the roles of paternalism and independent expertise. Discourse Studies 6 (1): 9–26. http://dx.doi.org/10.1177/1461445604039437
Ridsdale, L. and Hudd, S. (1994) Computers in the consultation: The patient’s view. British Journal of General Practice 44 (385): 367–369.
Roberts, C., Wass, V., Jones, R., Sarangi, S. and Gillett, A. (2003) A discourse analysis study of ‘good’ and ‘poor’ communication in an OSCE: A proposed new framework for teaching students. Medical Education 37 (3): 192–201. http://dx.doi.org/10.1046/j.1365-2923.2003.01443.x
Robinson, J. D. and Stivers, T. (2001) Achieving activity transitions in physician-patient encounters: From history taking to physical examination. Human Communication Research 27 (2): 253–298. http://dx.doi.org/10.1111/j.1468-2958.2001.tb00782.x
Ruusuvuori, J. (2001) Looking means listening: Coordinating displays of engagement in doctor-patient-interaction. Social Science and Medicine 52 (7): 1093–1108. http://dx.doi.org/10.1016/S0277-9536(00)00227-6
Sarangi, S. (2001) Editorial: On demarcating the space between ‘lay expertise’ and ‘expert laity’. Text and Talk 21 (1–2): 271–274. http://dx.doi.org/10.1515/text.1.21.1-2.3
Solomon, G. L. and Dechter, M. (1995) Are patients pleased with computer use in the examination room? Journal of Family Practice 41 (5): 241–244.
Stivers, T. (2001) Negotiating who presents the problem: Next speaker selection in pediatric encounters. Journal of Communication 51 (2): 252–282. http://dx.doi.org/10.1111/j.1460-2466.2001.tb02880.x
Stivers, T. (2002a) Participating in decisions about treatment: Overt parent pressure for antibiotic medication in pediatric encounters. Social Science and Medicine 54 (7): 1111–1130. http://dx.doi.org/10.1111/j.1460-2466.2001.tb02880.x
Stivers, T. (2002b) ‘Symptoms only’ and ‘candidate diagnoses’: Presenting the problem in pediatric encounters. Health Communication 14 (3): 299–338. http://dx.doi.org/10.1207/S15327027HC1403_22
Stivers, T. (2005a) Non-antibiotic treatment recommendations: Delivery formats and implications for parent resistance. Social Science and Medicine 60 (5): 949–964. http://dx.doi.org/10.1016/j.socscimed.2004.06.040
Stivers, T. (2005b) Parent resistance to physicians’ treatment recommendations: One resource for initiating a negotiation of the treatment decision. Health Communication 18 (1): 41–74. http://dx.doi.org/10.1207/s15327027hc1801_3
Stivers, T. (2006) The interactional process of reaching a treatment decision in acute medical encounters. In J. Heritage and D. Maynard (eds) Communication in Medical Care: Interactions between Primary Care Physicians and Patients, 279–312. Cambridge: Cambridge University Press.
Stivers, T. and Heritage, J. (2001) Breaking the sequential mold: Answering ‘more than the question’ during comprehensive history taking. Text and Talk 21 (1–2): 151–185. http://dx.doi.org/10.1515/text.1.21.1-2.151
Swinglehurst, D. (2014) Displays of authority in the clinical consultation: A linguistic ethnographic study of the electronic patient record. Social Science and Medicine 118: 17–26. http://dx.doi.org/10.1016/j.socscimed.2014.07.045
ten Have, P. (2001) Lay diagnosis in interaction. Text and Talk 21 (1–2): 251–260. http://dx.doi.org/10.1515/text.1.21.1-2.251
Tsai, M. (2007) Who gets to talk? An alternative framework evaluating companion effects in geriatric triads. Communication and Medicine 4 (1): 37–49. http://dx.doi.org/10.1515/CAM.2007.005
Vickers, C. H., Goble, R. and Deckert, S. K. (2015) Third party interaction in the medical context: Code-switching and control. Journal of Pragmatics 84: 154–171. http://dx.doi.org/10.1016/j.pragma.2015.05.009
Vickers, C. H., Goble, R. and Lindfelt, C. (2013) Narrative co-construction in the medical consultation: How agency and control affect the diagnosis. Communication and Medicine 9 (2): 159–171. http://dx.doi.org/10.1558/cam.v9i2.159
How to Cite
copyright Equinox Publishing Ltd.