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 (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.
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.
Coupland, Justine. 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.
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.
Laver, John. 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.
Laver, John. 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.
Menz, Florian. 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.
Menz, Florian. 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.
Roberts, Felicia D. 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.
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.
Spranz-Fogasy, Thomas. 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 (1)
Cited by one other publication
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 september 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.