Part of
Discourses of Helping ProfessionsEdited by Eva-Maria Graf, Marlene Sator and Thomas Spranz-Fogasy
[Pragmatics & Beyond New Series 252] 2014
► pp. 257–287
Edited by Eva-Maria Graf, Marlene Sator and Thomas Spranz-Fogasy
[Pragmatics & Beyond New Series 252] 2014
► pp. 257–287
Time pressure and digressive speech patterns in doctor-patient consultations
Who is to blame?
Medicine counts among the oldest and institutionally best developed helping professions in Western societies. It finds itself characterized by a number of unique aspects, among which the increasing fragmentation of the medical sciences which in turn resulted in the “fragmentation of the patient” has been widely discussed. One of the most visible forms of fragmentation is the fragmentation of time in medical treatment represented by small time slots and long waits for the patients. Physicians, frequently blame verbose patients, who cannot easily be prevented from talking, for increasing scheduling problems. This contribution, however, will present some opposing results. On the basis of a quantitative and qualitative analysis of 268 transcribed medical interviews the findings indicate that it is not so much the patients’ psychic structure (“being talkative”) that protracts medical consultations, but rather the physicians’ interactional patterns. For medical education (in particular, and counseling settings in general) these results might be of considerable interest as they counter popular prejudices on patient behavior and might contribute to reshaping the doctor-patient relationship.
References
Benjamin, N., C.A. Haden, and E. Wilkerson
2010 “Enhancing Building, Conversation, and Learning Through Caregiver-child Interactions in a Children’s Museum.” Developmental psychology 46 (2): 502–15. 
Bergner, Thomas M.H
2009 Wie geht’s uns denn? Ärztliche Kommunikation optimieren; mit 37 Übungen und STEPS, 11 Tabellen. Stuttgart, New York, NY: Schattauer.
Bernzweig, J., J.I. Takayama, C. Phibbs, C. Lewis, and R.H. Pantell
1997 “Gender Differences in Physician-patient Communication. Evidence from Pediatric Visits.” Archives of Pediatrics & Adolescent Medicine 151 (6): 586–591.
Bodamer, Joachim
1962 Arzt und Patient. Freiburg/Breisgau: Herder.
Brünner, Gisela
2005 “Arzt-Patienten-Kommunikation als Experten-Laien-Kommunikation.” In Psychosomatische Gesprächsführung in der Frauenheilkunde. Ein interdisziplinärer Ansatz zur verbalen Intervention, ed. by Mechthild Neises, Susanne Ditz, and Thomas Spranz-Fogasy, 90–109. Stuttgart: Wissenschaftliche Verlagsgesellschaft.
Button, Graham, and John R.E. Lee
(eds) 1987 Moving Out of Closings. Bristol: Multilingual Matters.
Button, Graham
1991 “Conversation-in-a-Series.” In Talk and Social Structure: Studies in Ethnomethodology and Conversational Analysis, ed. by Deirdre Zimmerman, and Don H. Boden, 251–277. Bristol: Polity Press.
Byrne, Patrick S., and Barrie E.L. Long
1976 Doctors Talking to Patients: A Study of the Verbal Behaviour of General Practitioners Consulting in Their Surgeries. London: HSMO, Royal College of General Practitioners.
Coupland, Justine
2000a “Introduction.” In Small Talk, ed. by Justine Coupland, 1–25.
London: Pearson Education.
2000b Small Talk. London: Pearson Education.
Coupland, Justine, Nikolas Coupland, and Jeffrey D. Robinson
1992 “‘How Are You?’ Negotiating Phatic Communion.” Language in Society 21: 207–230.
Faust, Volker, and Joachim Sandner
2010 Gesprächs-Art der “schwierige” Patient. Praxishandbuch.Köln: Ed. FORTHE.
Fisher, Sue
1993 “Doctor Talk/Patient Talk: How Treatment Decisions are Negotiated in Doctor-patient Communication.” In The Social Organization of Doctor-Patient Communication, ed. by Alexandra Dundas Todd, and Sue Fisher, 161–182. Norwood: Ablex Publishing Corporation.
Geisler, Regina
2011 ‘Zwei-Klassen-Medizin’ in Österreichs hausärztlichen Ordinationen? Gesprächsanalytische Untersuchung zu Differenzen in der ärztlichen Kommunikation bei Wahl- und KassenärztInnen. Wien: Universität Wien.
Gruber, Helmut, and Florian Menz
2004 “Introduction: Language and Political Change. Micro- and Macro-aspects of a Contested Relationship?” Journal of Language and Politics 3 (2): 175–188.
Habscheid, Stephan
2003 Sprache in der Organisation. Sprachreflexive Verfahren im systemischen Beratungsgespräch. Berlin: de Gruyter.
Heritage, John C., and Jeffrey D. Robinson
2006 “The Structure of Patients’ Presenting Concerns: Physicians’ Opening Questions.” Health Communication 19 (2): 89–102.
Holmes, Janet
2000 “Doing Collegiality and Keeping Control at Work.” In Small Talk, ed. by Justine Coupland, 32–61. London: Pearson Education.
Hudak, P.L., and D.W. Maynard
2011 “An Interactional Approach to Conceptualising Small Talk in Medical Interactions.” Sociology of Health & Illness 33 (4): 634–653.
Isaacs, T., M.D. Laurier, C.E. Turner, and N. Segalowitz
2011 “Identifying Second Language Speech Tasks and Ability Levels for Successful Nurse Oral Interaction with Patients in a Linguistic Minority Setting: an Instrument Development Project.” Health Communication 26 (6): 560–570.
Jefferson, Gail
1973 “A Case of Precision Timing in Ordinary Conversation: Overlapped Tag-positioned Address Terms in Closing Sequences. ” Semiotica 9: 47–96.
Koerfer, A., K. Köhle, R. Obliers, B. Sonntag, W. Thomas, and C. Albus
2008 “Training und Prüfung kommunikativer Kompetenz. Aus- und Fortbildungskonzepte zur ärztlichen Gesprächsführung.” Gesprächsforschung – Online-Zeitschrift zur verbalen Interaktion 9: 34–78.
König, Jan C.L, and Ernest W.B. Hess-Lüttich
2012 “Medizinische Kommunikation.” In Historisches Wörterbuch der Rhetorik, ed. by Gert Ueding, 660–669. Berlin: De Gruyter.
Lalouschek, Johanna
2004 “Kommunikatives Selbst-Coaching im beruflichen Alltag. Ein sprachwissenschaftliches Trainingskonzept am Beispiel der klinischen Gesprächsführung.” In Analyse und Vermittlung von Gesprächskompetenz, ed. by Michael Becker-Mrotzek, and Gisela Brünner, 137–158. Mannheim: Verlag für Gesprächsforschung.
Lalouschek, Johanna, Florian Menz, and Ruth Wodak
1990 Alltag in der Ambulanz. Gespräche zwischen Ärzten, Schwestern und Patienten. Tübingen: Gunter Narr Verlag. Reprint, NOT IN FILE.
Laver, John
1974 “Communicative Functions of Phatic Communion.” Work in Progress 7: 1–17.
1975 “Communicative Functions of Phatic Communion” In Organization of Behavior in Face-to-Face Interaction, ed. by A. Harris, R.M. Key, and M.R. Kendo, 215–238. Berlin: Mouton de Gruyter.
1981 “Linguistic Routines and Politeness in Greeting and Parting.” In Conversational Routine, 289–304. Berlin: Mouton de Gruyter.
Malinowski, B
1923 “The Problem of Meaning in Primitive Languages.” In The Meaning of Meaning, ed. by C.K. Richards, I.A. Ogden, 146–152. London: Routledge.
Maynard, Douglas W
1991 “Interaction and Asymmetry in Clinical Discourse.” The American Journal of Sociology 97 (2): 448–495.
Maynard, Douglas W., and Pamela L. Hudak
2008.“Small Talk, High Stakes: Interactional Disattentiveness in the Context of Prosocial Doctor-Patient Interaction.” Language in Society 37 (05): 661–688.
Menz, Florian
1991 Der geheime Dialog. Medizinische Ausbildung und institutionalisierte Verschleierungen in der Arzt- Patient-Kommunikation. Frankfurt/Main: Peter Lang.
1994 “Der Einfluß von medizinischer Ausbildung und von Kontingenzen auf das ärztliche Gespräch im Krankenhaus. Aprioris einer kommunikativen Schulung des medizinischen Krankenhauspersonals.” In Medizinische Kommunikation. Diskurspraxis, Diskursethik, Diskursanalyse, ed. by Angelika Redder and Ingrid Wiese, 218–234. Opladen: Westdeutscher Verlag.
2012 “Zum Vergleich von ärztlichen Konsultationen zu Kopfschmerzen bei gedolmetschten und nicht gedolmetschten Gesprächen.” In Migration und medizinische Kommunikation, ed. by Florian Menz. Wien: v&r Vienna University Press.
Menz, Florian, and Ali Al-Roubaie
2008 “Interruptions, Status and Gender in Medical Interviews: the Harder you Brake, the Longer it Takes.” Discourse & Society 19 (5): 645–666.
Menz, Florian, Johanna Lalouschek, and Andreas Gstettner
2008 Effiziente ärztliche Gesprächsführung. Optimierung kommunikativer Kompetenz in der ambulanten medizinischen Versorgung. Ein gesprächsanalytisches Trainingskonzept. Münster: LIT.
Menz, Florian, and Luzia Plansky
2010 Kommunikationsmuster und Gesprächstechniken zur Compliance-Förderung von PatientInnen. Wien: Universität Wien.
Mishler, Elliot G
1984 The Discourse of Medicine. Dialectics of Medical Interviews. Norwood, New Jersey: Ablex.
Plassmann, Reinhard
1996 Der schwierige Patient. Aachen: Shaker.
Raspe, Hans-Heinrich
1982 “Visitenforschung in der Bundesrepublik: Historische Reminiszenzen und Ergebnisse formal-qualitativer Analysen.” In Das Gespräch während der ärztlichen Visite. Empirische Untersuchungen, ed. by Karl Köhle and Hans-Heinrich Raspe, 1–15. München; Wien; Baltimore: Urban & Schwarzenberg.
Rehbein, Jochen, et al.
2004 “Handbuch für das computergestützte Transkribieren nach HIAT.” Arbeiten zur Mehrsprachigkeit, Folge B. 56: 1–79.
Roberts, Felicia D
2000 “The Interactional Construction of Asymmetry: The Medical Agenda as a Resource for Delaying Response to Patient Questions.” The Sociological Quarterly 41 (1): 151–170.
2006 “Continuities and Discontinuities in Doctor-Patient Consultations in a Multilingual Society.” In Advances in Medical Discourse Analysis: Oral and Written Contexts, ed. by Maurizio Gotti, and Françoise Salager-Meyer, 177–195. Bern: Peter Lang.
Robinson, William P
1972 Language and Social Behavior. Harmondsworth: Penguin.
Rodondi, Pierre-Yves, et al.
2009 “Physician Response to “By-the-Way” Syndrome in Primary Care.” J Gen Intern Med 24 (6): 739–741.
Rohde, J.J
1974 Soziologie des Krankenhauses. Stuttgart: Enke.
Roter, D.L., G. Geller, B.A. Bernhardt, S.M. Larson, and T. Doksum
1999 “Effects of Obstetrician Gender on Communication and Patient Satisfaction.” Obstetrics and Gynaecology 93 (5 Pt 1): 635–641.
Roter, D.L., J.A. Hall, and Y. Aoki
2002 “Physician Gender Effects in Medical Communication: A Meta-analytic Review.” JAMA: The Journal of the American Medical Association 288 (6): 756–764.
Roter, Debra L., and Judith A. Hall
2004 “Physician Gender and Patient-Centered Communication: A Critical Review of Empirical Research.” Annual Review of Public Health 25 (1): 497–519.
Roter, Debra L., Mack Lipkin, and A. Korsgaard
1991 “Sex Differences in Patients’ and Physicians’ Communication During Primary Care Medical Visits.” Med Care 29 (11): 1083–1093.
Rousseaux, M., A. Seve, M. Vallet, F. Pasquier, and M.A. Mackowiak-Cordoliani
2010 “An Analysis of Communication in Conversation in Patients with Dementia.” Neuropsychologia 48 (13): 3884–90.
Sacks, Harvey, Emanuel A. Schegloff, and Gail Jefferson
1974 “A Simplest Systematics for the Organisation of Turn-Taking for Conversation.” Language 50: 696–735.
Schmidt, Thomas, and Kai Wörner
2005.“Erstellen und Analysieren von Gesprächskorpora mit EXMARaLDA.” Gesprächsforschung 6: 171–195.
2009 “EXMARaLDA – Creating, Analysing and Sharing Spoken Language Corpora for Pragmatic Research.” Pragmatics 19 (4): 565–582.
Siegrist, Johannes
1982 “Asymmetrische Kommunikation bei klinischen Visiten.” In Das Gespräch während der ärztlichen Visite, ed. by Karl Köhle, and Hans-Heinrich Raspe, 16–22. München: Urban & Schwarzenberg.
Simmons-Mackie, N., and R.J. Elman
2010 “Negotiation of Identity in Group Therapy for Aphasia: the Aphasia Cafe.” International journal of language & communication disorders / Royal College of Speech & Language Therapists 46(3): 312–323.
Spranz-Fogasy, Thomas
2005 “Kommunikatives Handeln in ärztlichen Gesprächen – Gesprächseröffnung und Beschwerdenexploration.” In Psychosomatische Gesprächsführung in der Frauenheilkunde. Ein interdisziplinärer Ansatz zur verbalen Intervention, ed. by Mechthild Neises, Susanne Ditz, and Thomas Spranz-Fogasy, 17–47. Wissenschaftliche Verlagsgesellschaft.
2010 “Verstehensdokumentation in der medizinischen Kommunikation: Fragen und Antworten im Arzt-Patient-Gespräch.” In Verstehen in Professionellen Handlungsfeldern, ed. by Arnulf Deppermann, Ulrich Reitemeier, Reinhold Schmitt, and Thomas Spranz-Fogasy, 27–116. Tübingen: Narr.
Szmuilowicz, E., A. el-Jawahri, L. Chiappetta, M. Kamdar, and S. Block
2010 “Improving Residents’ End-of-life Communication Skills with a Short Retreat: A Randomized Controlled Trial.” Journal of Palliative Medicine 13 (4): 439–452.
ten Have, Paul
1991 “Talk and Institution. A Reconsideration of the ‘Asymmetry’ of Doctor-patient Interaction.” In Talk and Social Structure. Studies on Ethnomethology and Conversation Analysis, ed. by Deirdre Boden, and Don H. Zimmerman, 139–163. Bristol: Polity Press.
West, Candace
2006 “Coordinating Closings in Primary Care Visits: Producing Continuity of Care.” In Communication in Medical Care: Interaction Between Primary Care Physicians and Patients, ed. by John C. Heritage, and Douglas W. Maynard, 379–415. Cambridge: Cambridge University Press.
Cited by
Cited by 1 other publications
Álvaro Aranda, Cristina & Raquel Lázaro Gutiérrez
2022. Functions of small talk in healthcare interpreting: an exploratory study in medical encounters facilitated by healthcare interpreters. Language and Intercultural Communication 22:1 ► pp. 21 ff. 
This list is based on CrossRef data as of 20 april 2024. Please note that it may not be complete. Sources presented here have been supplied by the respective publishers. Any errors therein should be reported to them.