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Part of
Discourses of Helping Professions
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.
Published online: 18 December 2014
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https://doi.org/10.1075/pbns.252.11men
References (61)
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. DOI logoGoogle Scholar
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.Google Scholar
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. DOI logoGoogle Scholar
Bodamer, Joachim. 1962. Arzt und Patient. Freiburg/Breisgau: Herder.Google Scholar
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.Google Scholar
Button, Graham, and John R.E. Lee (eds). 1987. Moving Out of Closings. Bristol: Multilingual Matters.Google Scholar
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.Google Scholar
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.Google Scholar
Coupland, Justine. 2000a. “Introduction.” In Small Talk, ed. by Justine Coupland, 1–25. 
London: Pearson Education.Google Scholar
. 2000b. Small Talk. London: Pearson Education.Google Scholar
Coupland, Justine, Nikolas Coupland, and Jeffrey D. Robinson. 1992. “‘How Are You?’ Negotiating Phatic Communion.” Language in Society 21: 207–230. DOI logoGoogle Scholar
Faust, Volker, and Joachim Sandner. 2010. Gesprächs-Art der “schwierige” Patient. Praxishandbuch.Köln: Ed. FORTHE.Google Scholar
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.Google Scholar
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.Google Scholar
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. DOI logoGoogle Scholar
Habscheid, Stephan. 2003. Sprache in der Organisation. Sprachreflexive Verfahren im systemischen Beratungsgespräch. Berlin: de Gruyter. DOI logoGoogle Scholar
Heritage, John C., and Jeffrey D. Robinson. 2006. “The Structure of Patients’ Presenting Concerns: Physicians’ Opening Questions.” Health Communication 19 (2): 89–102. DOI logoGoogle Scholar
Holmes, Janet. 2000. “Doing Collegiality and Keeping Control at Work.” In Small Talk, ed. by Justine Coupland, 32–61. London: Pearson Education.Google Scholar
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. DOI logoGoogle Scholar
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. DOI logoGoogle Scholar
Jefferson, Gail. 1973. “A Case of Precision Timing in Ordinary Conversation: Overlapped Tag-positioned Address Terms in Closing Sequences. ” Semiotica 9: 47–96. DOI logoGoogle Scholar
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.Google Scholar
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.Google Scholar
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.Google Scholar
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.Google Scholar
Laver, John. 1974. “Communicative Functions of Phatic Communion.” Work in Progress 7: 1–17.Google Scholar
. 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.Google Scholar
. 1981. “Linguistic Routines and Politeness in Greeting and Parting.” In Conversational Routine, 289–304. Berlin: Mouton de Gruyter.Google Scholar
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.Google Scholar
Maynard, Douglas W. 1991. “Interaction and Asymmetry in Clinical Discourse.” The American Journal of Sociology 97 (2): 448–495. DOI logoGoogle Scholar
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. DOI logoGoogle Scholar
Menz, Florian. 1991. Der geheime Dialog. Medizinische Ausbildung und institutionalisierte Verschleierungen in der Arzt- Patient-Kommunikation. Frankfurt/Main: Peter Lang.Google Scholar
. 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. DOI logoGoogle Scholar
. 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.Google Scholar
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. DOI logoGoogle Scholar
Menz, Florian, Johanna Lalouschek, and Andreas Gstettner. 2008. Effiziente ärztliche Gesprächsführung. Optimierung kommunikativer Kompetenz in der ambulanten medizinischen Versorgung. Ein gesprächsanalytisches Trainingskonzept. Münster: LIT.Google Scholar
Menz, Florian, and Luzia Plansky. 2010. Kommunikationsmuster und Gesprächstechniken zur Compliance-Förderung von PatientInnen. Wien: Universität Wien.Google Scholar
Mishler, Elliot G. 1984. The Discourse of Medicine. Dialectics of Medical Interviews. Norwood, New Jersey: Ablex.Google Scholar
Plassmann, Reinhard. 1996. Der schwierige Patient. Aachen: Shaker.Google Scholar
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.Google Scholar
Rehbein, Jochen, et al. 2004. “Handbuch für das computergestützte Transkribieren nach HIAT.” Arbeiten zur Mehrsprachigkeit, Folge B. 56: 1–79.Google Scholar
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. DOI logoGoogle Scholar
. 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.Google Scholar
Robinson, William P. 1972. Language and Social Behavior. Harmondsworth: Penguin.Google Scholar
Rodondi, Pierre-Yves, et al. 2009. “Physician Response to “By-the-Way” Syndrome in Primary Care.” J Gen Intern Med 24 (6): 739–741.Google Scholar
Rohde, J.J. 1974. Soziologie des Krankenhauses. Stuttgart: Enke.Google Scholar
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. DOI logoGoogle Scholar
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. DOI logoGoogle Scholar
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. DOI logoGoogle Scholar
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. DOI logoGoogle Scholar
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. DOI logoGoogle Scholar
Sacks, Harvey, Emanuel A. Schegloff, and Gail Jefferson. 1974. “A Simplest Systematics for the Organisation of Turn-Taking for Conversation.” Language 50: 696–735. DOI logoGoogle Scholar
Schmidt, Thomas, and Kai Wörner. 2005.“Erstellen und Analysieren von Gesprächskorpora mit EXMARaLDA.” Gesprächsforschung 6: 171–195.Google Scholar
. 2009. “EXMARaLDA – Creating, Analysing and Sharing Spoken Language Corpora for Pragmatic Research.” Pragmatics 19 (4): 565–582. DOI logoGoogle Scholar
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.Google Scholar
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.Google Scholar
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.Google Scholar
. 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.Google Scholar
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. DOI logoGoogle Scholar
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.Google Scholar
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. DOI logoGoogle Scholar
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