Getting to ‘no’

Three ways to jointly accomplish an answer to questions in a questionnaire in doctor–patient interaction

  • Elisabeth Muth Andersen University of Southern Denmark
  • Gitte Rasmussen University of Southern Denmark
  • Catherine E. Brouwer University of Southern Denmark
  • Jytte Isaksen University of Southern Denmark
Keywords: doctor–patient interaction, ethnomethodological conversation analysis, questionnaires, question-answer sequences

Abstract

This paper aims to describe the interactional processes through which a medical professional and a patient collaboratively accomplish filling out answers to a questionnaire. Empirical analysis of three different sequences from a video-recorded doctor-patient interaction in which questions of a questionnaire were answered with a ‘no' reveals three different ways (or methods) in which doctor and patient accomplish this jointly. Applying ethnomethodological conversation analysis (EMCA) as our methodological framework, we conclude that the three interactional practices are fitted in relation to the constraints of the interview that is itself methodically aligned to the practices and organizational structures of the institution, a Danish hospital. Furthermore, we make the case that questionnaires are designed as idealizations of question-answer sequences, and as such do not operate at the same level of detail as the actual question-answer situation. Details that are crucial for the objective of the questionnaire (in this case providing information to a third party) may not be included in the recorded answer. Thus, we argue that in order to understand the informational value of recorded answers in questionnaires, we need to diagnose the interaction in which they were produced, i.e. to critically examine it.

Author Biographies

Elisabeth Muth Andersen, University of Southern Denmark

Elisabeth Muth Andersen is an Assistant Professor at the Department of Language and Communication, University of Southern Denmark, and a member of the research group Social Practices and Cognition. Her PhD explores micro-analytic methodologies (EM/CA) used on the analysis of online health communication (Andersen 2015). Her research focuses on social interaction and language use in various kinds of healthcare and institutional settings.

Gitte Rasmussen, University of Southern Denmark

Gitte Rasmussen is Professor with Special Responsibilities in the area of Social Practices and Cognition in the Department of Language and Communication, University of Southern Denmark. Her research interests especially concern the study of how people conduct social affairs in everyday professional environments, in which they presumably participate with different access to knowledge, skills or competences. Recent publications include papers in Clinical Linguistics and Phonetics, Journal of Pragmatics and Pragmatics and Society.

Catherine E. Brouwer, University of Southern Denmark

Catherine E. Brouwer received her PhD in applied linguistics from the University of Southern Denmark, and she is currently Associate Professor at the Department of Language and Communication at the University of Southern Denmark. Her research interests include professional communication within the health sector and language pedagogy. Recent publications concern interaction in the audiology clinic, interaction in aphasia interventions and speech and language therapy consultation for children.

Jytte Isaksen, University of Southern Denmark

Jytte Isaksen is Assistant Professor at the Department of Language and Communication, University of Southern Denmark, and is a member of the research group Social Practices and Cognition. She researches clinical issues in aphasia therapy such as clinical communication and partner training, mainly with qualitative approaches. She teaches aphasia, evidence-based practice and research methodology, amongst other topics in the Audiology and Speech-Language Therapy programs.

References

Andersen, E. M. (2015) What’s Your Problem?: On How Participants Understand and Deal with Experienced Bodily Problems in an Online Discussion Forum about Metabolism - A Contribution to Micro Analytic Research that Investigate Online Data. Unpublished doctoral dissertation, University of Southern Denmark, Odense.

Brouwer, C. E. (2012) Talking ‘cognition’in the audiology clinic. In G. Rasmussen, C. E. Brouwer and D. Day (eds) Evaluating Cognitive Competences in Interaction, 189-210. Amsterdam: John Benjamins. https://doi.org/10.1075/pbns.225.09bro

Brouwer, C. E. and Day, D. (2012) WHO/ICF guidelines and compliance in a hearing aid consultation. In M. Egbert and A. Deppermann (eds) Hearing Aids Communication: Integrating Social Interaction, Audiology and User Centered Design to Improve Communication with Hearing Loss and Hearing Technologies, 125-137. Mannheim, Germany: Verlag fûr Gesprächsforschung.

Clemente, I. (2010) Progressivity and participation: Children’s management of parental assistance in paedicatric chronic pain encounters. In A. Pilnick, J. Hindmarsh and V. T. Gill (eds) Comunication in Healthcare Settings. Policy, Participation and New Technologies, 73-98. Chichester, UK: Wiley-Blackwell. https://doi.org/10.1002/9781444324020.ch6

Drew, P. and Heritage, J. (eds) (1992) Talk at work: Interaction in institutional settings. Cambridge: Cambridge University Press.

Goffman, E. (1981) Forms of Talk. Oxford: Blackwell.

Heinemann, T. and Matthews, B. (2015) Concessions in audiology. In F. H. G. Chevalier and J. Moore (eds) Avoidance and Withholding in Institutional Interaction, 337-367. Amsterdam: John Benjamins.
https://doi.org/10.1075/pbns.255.11hei

Hepburn, A. and Bolden, G. (2013) The conversation analytic approach to transcription. In J. Sidnell and T. Stivers (eds) The Handbook of Conversation Analysis, 57-76. Oxford: Blackwell.
https://doi.org/10.1002/9781118325001.ch4

Heritage, J. (2010) Questioning in medicine. In A. F. Freed and S. Ehrlich (eds) Why Do You Ask, 42-68. New York: Oxford University Press. https://doi.org/10.1093/acprof:oso/9780195306897.003.0003

Heritage, J., Elliott, M. N., Stivers, T., Richardson, A. and Mangione-Smith, R. (2010) Reducing inappropriate antibiotics prescribing: The role of online commentary on physical examination findings. Patient Education and Counseling 81 (1): 119-125. https://doi.org/10.1016/j.pec.2009.12.005

Heritage, J., and Maynard, D. W. (eds) (2006) Communication in Medical Care: Interaction between Primary Care Physicians and Patients. Studies in Interactional Sociolinguistics 20. Cambridge: Cambridge University Press. https://doi.org/10.1017/CBO9780511607172

Heritage, J., and Robinson, J. D. (2006). Accounting for the visit: Giving reasons for seeking medical care. In J. Heritage and D. Maynard (eds) Communication in Medical Care: Interaction between Primary Care Physicians and Patients. Studies in Interactional Sociolinguistics 20: 48-85. Cambridge: Cambridge University Press. https://doi.org/10.1017/CBO9780511607172.005

Heritage, J. and Sorjonen, M.-L. (1994) Constituting and maintaining activities across sequences: And-prefacing as a feature of question design. Language in Society 23 (1): 1-29.
https://doi.org/10.1017/S0047404500017656

Houtkoop-Steenstra, H. (1986) Claimen versus demonstreren. Tijdschrift voor Taalbeheersing 8: 222-234.

Houtkoop-Steenstra, H. (2000) Interaction and the Standardized Survey Interview: The Living Questionnaire. Cambridge: Cambridge University Press. https://doi.org/10.1017/CBO9780511489457

Isaksen, J. and Brouwer, C. E. (2015) Assessments in outcome evaluation in aphasia therapy: Substantiating the claim. Journal of Interactional Research in Communication Disorders 6 (1): 71-95.
https://doi.org/10.1558/jircd.v6i1.71

Martin, C. (2009) Relevance of situational context in studying learning as changing participation. Scandiavian Journal of Educational Research 53 (2): 133-149. https://doi.org/10.1080/00313830902757568

Maynard, D. W., Houtkoop-Steenstra, H., Schaeffer, N. C. and van der Zouwen, J. (eds) (2002) Standardization and Tacit Knowledge: Interaction and Practice in the Survey Interview. New York: John Wiley.

Maynard, D. W. and Clayman, S. E.. (1991) The diversity of ethnomethodology. Annual Review of Sociology 17: 385-418. https://doi.org/10.1146/annurev.so.17.080191.002125

Pilnick, A., Hindmarsh, J. and Gill, V. T. (2010) Beyond ‘doctor and patient’: Developments in the study of healthcare interactions. In A. Pilnick, J. Hindmarsh and V. T. Gill (eds) Communication in Healthcare Settings: Participation, Policy and New Technologies, 1-16. Chichester, UK: Wiley-Blackwell. https://doi.org/10.1002/9781444324020.ch1

Rasmussen, G. (2013) That’s my story! Resisting disabling processes in a therapeutic activity. Journal of Interactional Research in Communication Disorders 4 (2): 273-298. https://doi.org/10.1558/jircd.v4i2.273

Rasmussen, G. (2016) The International Classification of Disability, Functioning and Health (ICF) - an example of research methods and language in describing ‘social functioning’ in medical research. Pragmatics and Society 7 (2): 217-238. https://doi.org/10.1075/ps.7.2.03ras

Rasmussen, G. (2017) On the social constraints of having a world. RASK International Journal of Language and Communication 47: 79-107.

Raymond, G. (2003) Grammar and social organization: Yes/no interrogatives and the structure of responding. American Sociological Review 68 (6): 939-967. https://doi.org/10.2307/1519752

Rossano, F. (2013) Gaze in conversation. In J. Sidnell and T. Stivers (eds) The Handbook of Conversation Analysis, 308-329. Oxford: Blackwell. https://doi.org/10.1002/9781118325001.ch15

Schegloff, E. A. (2007) Sequence Organization in Interaction: A Primer in Conversation Analysis. Cambridge: Cambrigde University Press. https://doi.org/10.1017/CBO9780511791208

Stivers, T. (2010) An overview of the question-response system in American English conversation. Journal of Pragmatics 42 (10): 2772-2781. https://doi.org/10.1016/j.pragma.2010.04.011

Wilkinson, R. (2015) Conversation and aphasia: Advances in analysis and intervention. Aphasiology 29 (3): 257-268. https://doi.org/10.1080/02687038.2014.974138
Published
2019-07-03
How to Cite
Andersen, E. M., Rasmussen, G., Brouwer, C. E., & Isaksen, J. (2019). Getting to ‘no’. Communication & Medicine, 15(1), 1-13. https://doi.org/10.1558/cam.32459
Section
Articles