Cover not available
Part of
Relationships in Organized Helping: Analyzing interaction in psychotherapy, medical encounters, coaching and in social media
Edited by Claudio Scarvaglieri, Eva-Maria Graf and Thomas Spranz-Fogasy
[Pragmatics & Beyond New Series 331] 2022
► pp. 243–264

Building (dis-)affiliative medical relationships through interactional practices of knowledge management

A comparative study of German and Bosnian medical encounters

| University of Sarajevo

The goal of the current contribution is to consider and compare different aspects of (dys-)functional knowledge management indexed by a conflict involving epistemics in Bosnian and German language. My research draws on 42 audiotaped conversations of Bosnian and German doctors with their patients. The data was analyzed using Conversation Analysis.

This paper focuses first on the Bosnian data in which patients display an inability to provide the requested information or display reduced access to information they are accountable for (Heritage 2012). Interactional practices of dysfunctional knowledge management lead to misunderstandings, a break in the progressivity of the interaction, or face threatening actions such as criticism and disciplining of the patient (Holly 2001). In contrast, a focus on the German data shows a more patient-centered approach which entails more active patient participation. Furthermore, German patients display higher medical knowledge and more personal responsibility.

Keywords: doctor-patient relationship, conversation analysis, (dis-)affiliation, knowledge management, epistemics, Bosnian, German
Article outline
  • 1.Introduction
  • 2.Data
  • 3.Methodology
  • 4.Findings
    • 4.1Knowledge of medical history
    • 4.2Self-care related knowledge
  • 5.Discussion and conclusion
  • Notes
  • References
Published online: 7 September 2022
DOI logo
https://doi.org/10.1075/pbns.331.11dza
References
Anderson, Robert M., and Martha M. Funell
2005 The Art of Empowerment: Stories and Strategies for Diabetes Educators with CDROM. 2. edition, U.S.: American Diabetes Association.Google Scholar
Antaki, Charles
2008 “Formulations in psychotherapy.” In Conversation Analysis and Psychotherapie, ed. by Anssi Peräkyla, Charles Amtaki, Sanna Vehviläinen, and Ivan Leudar. 26–42. Cambridge: Cambridge University Press. DOI logoGoogle Scholar
Beach, Wayne A.
2011 “Lay Diagnosis: Special Issue in honour to the late Rober Hopper.” Text 21 (1/2): 13–18.Google Scholar
Boyd, Elizabeth, and John C. Heritage
2006 “Taking the history: questioning during comprehensive history-taking.” In Communication in Medical Care: Interaction Between Primary Care Physicians and Patients, ed. by John C. Heritage, and Douglas W. Maynard, 151–184. Cambridge: Cambridge University Press. DOI logoGoogle Scholar
Brown, Penelope, and Stephen C. Levinson
1987 Politeness: Some universals in language usage. Cambridge, New York: Cambridge University Press. DOI logoGoogle Scholar
Brünner, Gisela
2009 “Die Verständigung zwischen Arzt und Patient als Experten-Laien-Kommunikation.“ In Informiert und selbstbestimmt: Der mündige Bürger als mündiger Patient. [= Beiträge zum Gesundheitsmanagement Bd. 24], ed. by Norbert Klusen, Anja Fließgarten, und Thomas Nebling, 170–188. Baden-Baden: Nomos. DOI logoGoogle 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
Chatwin, John
2006 “Patient narratives: A micro-interactional analysis.” Communication & Medicine 3 (2): 113–123. DOI logoGoogle Scholar
Deppermann, Arnulf, and Thomas Spranz-Fogasy
2011 “Doctors’ questions as displays of understanding.” Communication & Medicine 8 (2): 111–122. DOI logoGoogle Scholar
Džanko, Minka
2020 Rollengebundene Asymmetrie in Arzt-Patient-Gesprächen. Ein Vergleich im Deutschen und Bosnischen. [Series Schriften des Europäischen Zentrums für Sprachwissenschaften (EZS)], ed. by Ludwig Eichinger et al.. Heidelberg: Universitätsverlag Winter.Google Scholar
Frankel, Richard M.
2001 “Clinical care and conversational contingencies: The role of patients’ self-diagnosis in medical encounters.” Text 21: 83–111.Google Scholar
Gill, Virginia, and Douglas W. Maynard
2006 “Explaining illness: patients’ proposals and physicians’ responses.” In Communication in Medical Care: Interaction Between Primary Care Physicians and Patients, ed. by John Heritage, and Douglas W Maynard, 115–150, Cambridge: Cambridge University Press. DOI logoGoogle Scholar
Gill, Virginia, and Felicia Roberts
2013 “Conversation analysis in medicine.” In The handbook of conversation analysis, ed. by Tanya Stivers, and John Sidnell, 575–92. Chichester: Wiley-Blackwell.Google Scholar
Goffman, Erving
1955 (1967) “On Face-Work: An Analysis of Ritual Elements in Social Interaction.” Psychiatry 18: 213–231. DOI logoGoogle Scholar
Gülich, Elisabeth
1999 “ ‘Experten’ und ‘Laien’: Der Umgang mit Kompetenzunterschieden am Beispiel medizinischer Kommunikation.“ In Werkzeug Sprache. Sprachpolitik, Sprachfähigkeit, Sprache und Macht, ed. by Union der deutschen Akademien der Wissenschaften zu Leipzig, 165–196. Hildesheim, Zürich, New York: Olms.Google Scholar
Günthner, Susanne
2019 “Namentliche Anreden in onkologischen Aufklärungsgesprächen: eine interaktional ausgerichtete Studie zu Formen und Funktionen onymischer Anreden.” Interaktion Sprache Arbeitspapierreihe: 1–29. [URL]Google Scholar
Halkowski, Tim, and Virginia Teas Gill
2010 “Conversation analysis and ethnomethodology: The centrality of interaction.” In The SAGE Handbook of Qualitative Methods in Health Research, ed. by Ivy Bourgeault, Robert Dingwall, and Ray de Vries, 212-228. London: Sage. DOI logoGoogle Scholar
Heritage, John
1984 “A change-of-state token and aspects of its sequential placement.” In Structures of social action, Studies in conversation analysis, ed. by Maxwell J. Atkinson, and John Heritage, 299–345. Cambridge: Cambridge University Press.Google Scholar
2009 “Negotiating the legitimacy of medical problems: A multi-phase concern for patients and physicians.” In Health Communication, ed. by Dale E. Brashers, and Daena J. Goldsmith, 147–164. New York: Routledge.Google Scholar
2010 “Questioning in Medicine.” In "Why Do You Ask?": The Function of Questions in Institutional Discourse, ed. by Alice Freed, and Susan Ehrlich, 42-68. New York: Oxford University Press.Google Scholar
2012 “Epistemics in Action: Action Formation and Territories of Knowledge.” Research on Language and Social Interaction 45: 1–29. DOI logoGoogle Scholar
2013 “Epistemics in conversation.” In The handbook of conversation analysis, ed. by Jack Sidnell, and Tanya Stivers, 370–394. Chichester: Wiley-Blackwell.Google Scholar
Heritage, John, and Douglas W. Maynard
2006 “Introduction: Analyzing primary care encounters.” In Communication in Medical Care: Interactions between Primary Care Physicians and Patients, ed. by John Heritage, and Douglas Maynard, 1–21. Cambridge: Cambridge University Press.Google Scholar
Heritage, John, and Jeffrey Robinson
2006 “Accounting for the visit: giving reasons for seeking medical care.” In Communication in Medical Care: Interactions between Primary Care Physicians and Patients, ed. by John Heritage, and Douglas W. Maynard, 48–85. Cambridge: Cambridge University Press. DOI logoGoogle Scholar
Heritage, John, and Steven Clayman
2010 Talk in Action, Oxford: Wiley Blackwell. DOI logoGoogle Scholar
Heritage, John, and Geoffrey Raymond
2012 “Navigating epistemic landscapes: Acquiescence, agency and resistance in responses to polar questions.” In Questions: Formal, Functional and Interactional Perspectives, ed. by Jan P. De Ruiter, 179–92. Cambridge: Cambridge University Press. DOI logoGoogle Scholar
2005 “The terms of agreement: Indexing epistemic authority and subordination in assessment sequences.” Social Psychology Quarterly 68 (1): 15–38. DOI logoGoogle Scholar
Holly, Werner
2001 “Beziehungsmanagement und Imagearbeit.“ In Text- und Gesprächslinguistik. Handbücher zur Sprach- und Kommunikationswissenschaft, ed. by Klaus Brinker et al.., 1382–1393. Berlin, New York: de Gruyter. DOI logoGoogle Scholar
Labov, William, and David Fanshel
1977 Therapeutic Discourse. Psychotherapy as Conversation. New York: Academic Press.Google Scholar
Lalouschek, Johanna
2008 “Ärztliche Gesprächspläne und Anliegen von PatientInnen in der chronischen Schmerzbehandlung. Arbeitspapier zum Forschungsprojekt „Schmerzdarstellung and Krankheitserzählung.” [URL]Google Scholar
Lindwall, Oskar, Gustav Lymer, and Jonas Ivarsson
2016 “Epistemic status and the recognizability of social actions.” Special Issue: The epistemics of Epistemics Vol. 18 (5): 500–525. DOI logoGoogle Scholar
Löning, Petra
1993 “Psychische Betreuung als kommunikatives Problem. Elizitierte Schilderung des Befindens und `ärztliches Zuhören´ in der onkologischen Facharztpraxis.“ In Arzt-Patienten-Kommunikation. Analysen zu interdisziplinären Problemen des medizinischen Diskurses, ed. by Petra Löning, and Jochen Rehbein, 191–227. Berlin [u.a.]: de Gruyter. DOI logoGoogle Scholar
Manning, Philip, and George Ray
2002 “Setting the agenda: an analysis of negotiation strategies in clinical talk.” Health Communication 14(4): 451–473. DOI logoGoogle Scholar
Mishler, Elliot G.
1984 The Discourse of Medicine: Dialectics of Medical Interviews. Norwood, N.J.: Ablex Publishing Corporation.Google Scholar
Muntigl, Peter, and Adam Horvath
2015 “The therapeutic relationship in action: how therapists and clients co-manage relational disaffiliation.” Psychotherapy Research 24 (3): 41–59.Google Scholar
Muntigl, Peter
et al. 2012 “Client attitudinal stance and therapist-client affiliation. A view from grammar and social interaction.” Research in Psychotherapy: Psychopathology, Process and Outcome 15(2): 117–130.Google Scholar
Norrby, Catrin
et al. 2015 “Interpersonal relationships in medical consultations. Comparing Sweden Swedish and Finland Swedish address practices.” Journal of Pragmatics: 121–38. DOI logoGoogle Scholar
Petermann, Franz
1998 Compliance and Selbstmanagement, Göttingen: Hogrefe Verlag.Google Scholar
Raymond, Geoffrey, and John Heritage
2006 “The epistemics of social relations: Owning grandchildren.” Language in Society 35(5): 677–705. DOI logoGoogle Scholar
Rehbein, Jochen
1993 “Ärztliches Fragen.“ In Arzt-Patienten-Kommunikation. Analysen zu interdisziplinären Problemen des medizinischen Diskurses, ed. by Petra Löning, and Jochen Rehbein, 311–364. Berlin [u.a.]: de Gruyter. DOI logoGoogle Scholar
Sacks, Harvey, Emanuel A. Schegloff, and Gail Jefferson
1974 “A simplest systematics for the organization of turn-taking for conversation.” Language 50: 696–735. DOI logoGoogle Scholar
Schegloff, Emanuel A.
2007 Sequence Organization in Interaction: A Primer in Conversation Analysis. Cambridge: Cambridge University Press. DOI logoGoogle Scholar
Selting, Margret
et al. 2009 “Gesprächsanalytisches Transkriptionssystem 2 (GAT 2).” Gesprächsforschung – Online Zeitschrift zur verbalen Interaktion 10: 353–402.Google Scholar
Sorjonen, Marja-Leena, Anssi Peräkylä, and Kari Eskola
2001 Keskustelu lääkärin vastaanotolla (Conversationata Doctor’s Consultation). Tampere: Vastapaino.Google Scholar
Spranz-Fogasy, Thomas
2005 “Kommunikatives Handeln in ärztlichen Gesprächen.“ In Psychosomatische Gesprächsführung in der Frauenheilkunde. Ein interdisziplinärer Ansatz zur verbalen Intervention, ed. by Mechthild Neises, Susanne Ditz, and Thomas Spranz-Fogasy, 17–47. Stuttgart: Wissenschaftliche Verlagsgesellschaft mbH.Google Scholar
2010 “Verstehensdokumentation in der medizinischen Kommunikation: Fragen und Antworten im Arzt-Patient-Gespräch.“ In Verstehen in professionellen Handlungsfeldern, ed. by Arnulf Deppermann et al.., 27–116. Tübingen: Narr Verlag.Google Scholar
2014 Die allmähliche Verfertigung der Diagnose im Reden. Prädiagnostische Mitteilungen im Gespräch zwischen Arzt und Patient. Berlin, Boston: de Gruyter. DOI logoGoogle Scholar
Stivers, Tanya
2008 “Stance, alignment and affiliation during storytelling: When nodding is a token of affiliation.” Research on Language and Social Interaction 41 (1): 31–57. DOI logoGoogle Scholar
Stivers, Tanya, and Federico Rossano
2010 “Mobilizing response.” Research on Language and Social Interaction 43 (1): 3–31. DOI logoGoogle Scholar
Stivers, Tanya, Lorenza Mondada, and Jakob Steensing
2011 “Knowledge, morality and affiliation in social interaction.” In The morality of knowledge in conversation, ed. By Tanya Stivers, Lorenza Mondada, and Jakob Steensing, 3–26. Cambridge: Cambridge University Press. DOI logoGoogle Scholar
Cited by

Cited by 1 other publications

Kabatnik, Susanne
2024. “Because he was disgusting”: transforming relations through positioning in messenger-supported group psychotherapy. Frontiers in Psychology 14 DOI logo

This list is based on CrossRef data as of 28 march 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.