Symptom assessment and patient resistance in primary care interactions in Chinese hospitals
DOI:
https://doi.org/10.1558/eap.34693Keywords:
conversation analysis, pragmatics of description, chinese primary care, diagnosis, resistanceAbstract
In a study of primary care consultations in Chinese western-style medicine, two recurrent interactional patterns have been identified which are associated with making medical assessments. At various points in a consultation, the clinician may indicate that the patient’s symptoms are ‘normal’ and that nothing is medically concerning or problematic. The patient may resist that by representing her condition as being in some fashion abnormal. By contrast, when the clinician considers the patient’s symptoms as abnormal, i.e. indicating a medical abnormality and worthy of medical care (i.e. doctorable), the patient may resist by normalising her symptoms. Through analysing doctors’ symptomatic accounts and patients’ resisting talk, ‘symptom abnormality’ emerges as the central form of expression at moments in which doctors and patients are misaligned in their diagnostic reasoning.
References
Byrne, P. S., & Long, B. E. (1976). Doctors talking to patients: A study of the verbal behaviour of general practitioners consulting in their surgeries. London: HMSO.
Clift, R. (2001). Meaning in interaction: The case of actually. Language, 77(2), 245–291. https://doi.org/10.1353/lan.2001.0074
Collins, S., Drew, P., Watt, I., & Entwistle, V. (2005). ‘Unilateral’ and ‘bilateral’ practitioner approaches in decision-making about treatment. Social Science & Medicine, 61(12), 2611–2627. https://doi.org/10.1016/j.socscimed.2005.04.047
Drew, P. (2003). Precision and exaggeration in interaction. American Sociological Review, 68(6), 917–938. https://doi.org/10.2307/1519751
Elsey, C., Drew, P., Jones, D., Blackburn, D., Wakefield, S., Harkness, K., Venneri, A. & Reuber, M. (2015). Towards diagnostic conversational profiles of patients presenting with dementia or functional memory disorders to memory clinics. Patient Education & Counselling, 98(9), 1071–1077. https://doi.org/10.1016/j.pec.2015.05.021
Jefferson, G. (1984). Transcript notation. In J. M. Atkinson & J. Heritage (Eds.), Structures of social action: Studies in conversation analysis (pp. ix–xvi). Cambridge: Cambridge University Press.
Heath, C. (1992). The delivery and reception of diagnosis in the general practice consultation. In J. Heritage (Ed.), Talk at work (pp. 235–267). Cambridge: Cambridge University Press.
Heath, C. (1997). The analysis of activities in face to face interaction using video. In D. Silverman (Ed.), Qualitative research: Theory, method and practice (pp. 183–200). London: Sage Publication.
Heritage, J., & Robinson, J. D. (2006a). The structure of patients’ presenting concerns: Physicians’ opening questions. Health Communication, 19(2), 89–102. https://doi.org/10.1207/s15327027hc1902_1
Heritage, J., & Robinson, J. (2006b). Accounting for the visit: Giving reasons for seeking medical care. In J. Heritage & D. Maynard (Eds.), Communication in medical care: Interaction between primary care physicians and patients (pp. 48–85). Cambridge: Cambridge University Press. https://doi.org/10.1017/CBO9780511607172.005
Labov, W., & Waletzky, J. (1997). Narrative analysis: Oral versions of personal experience. Seattle: University of Washington Press.
Perakyla, A. (1998). Authority and accountability: The delivery of diagnosis in primary health care. Social Psychology Quarterly, 61(4), 301–320. https://doi.org/10.2307/2787032
Perakyla, A. (2006). Communicating and responding to diagnosis. In J. Heritage & D. Maynard (Eds.), Communication in medical care: Interaction between primary care physicians and patients (pp. 214–247). Cambridge: Cambridge University Press. https://doi.org/10.1017/CBO9780511607172.010
Reuber, M., Monzoni, C., Sharrack, B., & Plug, L. (2009). Using interactional and linguistic analysis to distinguish between epileptic and psychogenic nonepileptic seizures: A prospective, blinded multirater study. Epilepsy & Behaviour, 16(1), 139–144. https://doi.org/10.1016/j.yebeh.2009.07.018
Robinson, J. D. (2003). An interactional structure of medical activities during acute visits and its implications for patients’ participation. Health Communication, 15(1), 27–59. https://doi.org/10.1207/S15327027HC1501_2
Robinson, J. D. (2006). Soliciting patients’ presenting concerns. In J. Heritage & D. Maynard (Eds.), Communication in medical care: Interaction between primary care physicians and patients (pp. 22–47). Cambridge: Cambridge University Press. https://doi.org/10.1017/CBO9780511607172.010
Robinson, J. D., & Heritage, J. (2005). The structure of patients’ presenting concerns: The completion relevance of current symptoms. Social Science & Medicine, 61(2), 481–493. https://doi.org/10.1016/j.socscimed.2004.12.004
Robinson, J. D., & Heritage, J. (2006). Physicians’ opening questions and patients’ satisfaction. Patient Education and Counseling, 60(3), 279–285. http://dx.doi.org/10.1016/j.pec.2005.11.009
Tagliamonte, S., & Roberts, C. (2005). So weird; so cool; so innovative: The use of intensifiers in the television series Friends. American Speech, 80(3), 280–300. https://doi.org/10.1215/00031283-80-3-280
Clift, R. (2001). Meaning in interaction: The case of actually. Language, 77(2), 245–291. https://doi.org/10.1353/lan.2001.0074
Collins, S., Drew, P., Watt, I., & Entwistle, V. (2005). ‘Unilateral’ and ‘bilateral’ practitioner approaches in decision-making about treatment. Social Science & Medicine, 61(12), 2611–2627. https://doi.org/10.1016/j.socscimed.2005.04.047
Drew, P. (2003). Precision and exaggeration in interaction. American Sociological Review, 68(6), 917–938. https://doi.org/10.2307/1519751
Elsey, C., Drew, P., Jones, D., Blackburn, D., Wakefield, S., Harkness, K., Venneri, A. & Reuber, M. (2015). Towards diagnostic conversational profiles of patients presenting with dementia or functional memory disorders to memory clinics. Patient Education & Counselling, 98(9), 1071–1077. https://doi.org/10.1016/j.pec.2015.05.021
Jefferson, G. (1984). Transcript notation. In J. M. Atkinson & J. Heritage (Eds.), Structures of social action: Studies in conversation analysis (pp. ix–xvi). Cambridge: Cambridge University Press.
Heath, C. (1992). The delivery and reception of diagnosis in the general practice consultation. In J. Heritage (Ed.), Talk at work (pp. 235–267). Cambridge: Cambridge University Press.
Heath, C. (1997). The analysis of activities in face to face interaction using video. In D. Silverman (Ed.), Qualitative research: Theory, method and practice (pp. 183–200). London: Sage Publication.
Heritage, J., & Robinson, J. D. (2006a). The structure of patients’ presenting concerns: Physicians’ opening questions. Health Communication, 19(2), 89–102. https://doi.org/10.1207/s15327027hc1902_1
Heritage, J., & Robinson, J. (2006b). Accounting for the visit: Giving reasons for seeking medical care. In J. Heritage & D. Maynard (Eds.), Communication in medical care: Interaction between primary care physicians and patients (pp. 48–85). Cambridge: Cambridge University Press. https://doi.org/10.1017/CBO9780511607172.005
Labov, W., & Waletzky, J. (1997). Narrative analysis: Oral versions of personal experience. Seattle: University of Washington Press.
Perakyla, A. (1998). Authority and accountability: The delivery of diagnosis in primary health care. Social Psychology Quarterly, 61(4), 301–320. https://doi.org/10.2307/2787032
Perakyla, A. (2006). Communicating and responding to diagnosis. In J. Heritage & D. Maynard (Eds.), Communication in medical care: Interaction between primary care physicians and patients (pp. 214–247). Cambridge: Cambridge University Press. https://doi.org/10.1017/CBO9780511607172.010
Reuber, M., Monzoni, C., Sharrack, B., & Plug, L. (2009). Using interactional and linguistic analysis to distinguish between epileptic and psychogenic nonepileptic seizures: A prospective, blinded multirater study. Epilepsy & Behaviour, 16(1), 139–144. https://doi.org/10.1016/j.yebeh.2009.07.018
Robinson, J. D. (2003). An interactional structure of medical activities during acute visits and its implications for patients’ participation. Health Communication, 15(1), 27–59. https://doi.org/10.1207/S15327027HC1501_2
Robinson, J. D. (2006). Soliciting patients’ presenting concerns. In J. Heritage & D. Maynard (Eds.), Communication in medical care: Interaction between primary care physicians and patients (pp. 22–47). Cambridge: Cambridge University Press. https://doi.org/10.1017/CBO9780511607172.010
Robinson, J. D., & Heritage, J. (2005). The structure of patients’ presenting concerns: The completion relevance of current symptoms. Social Science & Medicine, 61(2), 481–493. https://doi.org/10.1016/j.socscimed.2004.12.004
Robinson, J. D., & Heritage, J. (2006). Physicians’ opening questions and patients’ satisfaction. Patient Education and Counseling, 60(3), 279–285. http://dx.doi.org/10.1016/j.pec.2005.11.009
Tagliamonte, S., & Roberts, C. (2005). So weird; so cool; so innovative: The use of intensifiers in the television series Friends. American Speech, 80(3), 280–300. https://doi.org/10.1215/00031283-80-3-280
Published
2017-11-29
Issue
Section
Articles
How to Cite
Wu, L. (2017). Symptom assessment and patient resistance in primary care interactions in Chinese hospitals. East Asian Pragmatics, 2(2), 259-288. https://doi.org/10.1558/eap.34693
