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Interactional Sociolinguistics: Tracking Patient-Initiated Questions Across an Episode of Care

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Analysing Health Communication

Abstract

Even the most cursory search of the literature on language and communication in healthcare reveals a plethora of published research in the field. However, this body of work has historically been located in different disciplinary siloes and draws on very different research traditions and methodologies, often with little in the way of mutual interaction between them (Sarangi, Editorial: Towards a communicative mentality in medical and healthcare practice. Communication & Medicine, 1(1), 1–11, 2004). Most studies on communication within clinical and health sciences still rely heavily on reported data from interviews and surveys, or on high-level coding of consultation structure and content, and aim to answer practical questions about how provider-patient communication influences health outcomes. By contrast, studies based in humanities and social sciences fields such as linguistics and medical sociology are more likely to have a descriptive or theoretical lens on direct observation and/or critical analysis of institutional structures and processes, even when they are framed as applied research. This can make such work less accessible to professional and other clinical audiences, and even where this is not the case, non-clinical researchers may not always be well placed to explicitly address matters of application and ‘practical relevance’ (Roberts and Sarangi, Talk, work and institutional order discourse in medical, mediation and management settings. Berlin and New York: Mouton de Gruyter, 1999).

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Notes

  1. 1.

    The entire data set of 182 consultations was added to the ARCH Corpus of Health Interactions (Stubbe 2017a), a curated digital archive supported by a customised relational database and available for re-use by approved researchers and educators (https://www.otago.ac.nz/wellington/research/arch/corpus/).

  2. 2.

    Frequency of patient questions has long been considered an indicator of level of participation in the medical interaction (Roter 1977; Street and Millay 2001).

References

  • Albury, C., Hall, A., Syed, A., Ziebland, S., Stokoe, E., Roberts, N., Webb, H., & Aveyard, P. (2019). Communication practices for delivering health behaviour change conversations in primary care: A systematic review and thematic synthesis. BMC Family Practice, 20(1), 111.

    Article  Google Scholar 

  • Ariss, S. (2009). Asymmetrical knowledge claims in general practice consultations with frequently attending patients: Limitations and opportunities for patient participation. Social Science and Medicine, 69, 908–919.

    Article  Google Scholar 

  • Auer, P., & Roberts, C. (2011). Introduction: John Gumperz and the indexicality of language. Text & Talk—An Interdisciplinary Journal of Language, Discourse & Communication Studies, 31(4), 381–393.

    Google Scholar 

  • Barnes, R. K. (2017). Preliminaries to treatment recommendations in UK primary care: A vehicle for shared decision making? Health Communication, 33(11), 1366–1376.

    Article  Google Scholar 

  • Barton, J., Dew, K., Dowell, A., Sheridan, N., Kenealy, T., Macdonald, L., Docherty, B., Tester, B., Raphael, D., Gray, L., & Stubbe, M. (2016). Patient resistance as a resource: Candidate obstacles in diabetes consultations. Sociology of Health & Illness, 38(7), 1151–1166.

    Article  Google Scholar 

  • Byrne, P. S., & Long, B. (1976). Doctors talking to patients. A study of the verbal behaviour of general practitioners consulting in their surgeries. London: Her Majesty’s Stationary Office.

    Google Scholar 

  • Cicourel, A. V. (1992). The interpretation of communicative contexts: Examples from medical encounters. In A. Duranti & C. Goodwin (Eds.), Rethinking context: Language as an interactive phenomenon (pp. 291–310). Cambridge: Cambridge University Press.

    Google Scholar 

  • Collins, S., Britten, N., Ruusuwuori, J., & Thompson, A. (2007). Patient participation in health care consultations: Qualitative perspectives. Maidenhead: McGraw-Hill/Open University Press.

    Google Scholar 

  • 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.

    Article  Google Scholar 

  • Cook-Gumperz, J. (2001). Cooperation, collaboration and pleasure in work. In A. di Luzio, S. Gunthner & F. Orletti (Eds.), Culture in communication: Analyses of intercultural situations (pp. 117–39). Amsterdam: John Benjamins.

    Google Scholar 

  • Crawford, P., Brown, B., & Harvey, K. (2014). Corpus linguistics and evidence-based health communication. In H. Hamilton & W. S. Chou (Eds.), The Routledge handbook of language and health communication (pp. 75–90). London and New York: Routledge.

    Google Scholar 

  • Dew, K., Stubbe, M., Macdonald, L., Dowell, A., & Plumridge, E. (2010). The (non) use of prioritisation protocols by surgeons. Sociology of Health & Illness, 32(4), 545–562.

    Article  Google Scholar 

  • Dowell, A., Stubbe, M., Macdonald, L., Tester, R., Gray, L., Vernall, S., Kenealy, T., Sheridan, N., Docherty, B., Hall, D.-A., Raphael, D., & Dew, K. (2018). A longitudinal study of interactions between health professionals and people with newly diagnosed diabetes. The Annals of Family Medicine, 16(1), 37–44.

    Article  Google Scholar 

  • Dowell, A., Stubbe, M., Scott-Dowell, K., Macdonald, L., & Dew, K. (2013). Talking with the alien: Interaction with computers in the GP consultation. Australian Journal of Primary Health, 29, 275–282.

    Article  Google Scholar 

  • Erickson, F. (2011). From speech as “situated” to speech as “situating”: Insights from John Gumperz on the practical conduct of talk as social action. Text & Talk: An Interdisciplinary Journal of Language, Discourse & Communication Studies, 31(4), 395–406.

    Article  Google Scholar 

  • Frankel, R. (1990). Talking in interviews: A dispreference for patient-initiated questions in physician-patient encounters. In G. Psathas (Ed.), Interaction competence: Studies in ethnomethodology and conversation analysis (pp. 231–262). Lanham, MD: University Press of America.

    Google Scholar 

  • Gafaranga, J., & Britten, N. (2003). “Fire away”: The opening sequence in general practice consultations. Family Practice, 20(3), 242–247.

    Article  Google Scholar 

  • Gardner, J., Dew, K., Stubbe, M., Dowell, T., & Macdonald, L. (2011). Patchwork diagnoses: The production of coherence, uncertainty, and manageable bodies. Social Science & Medicine, 73(6), 843–850.

    Article  Google Scholar 

  • Gee, J. P. (2014). An introduction to discourse analysis: Theory and method. London and New York: Routledge.

    Book  Google Scholar 

  • Gill, V. T., & Maynard, D. W. (2006). Explaining illness: Patients’ proposals and physicians’ responses. In J. Heritage & D. W. Maynard (Eds.), Communication in medical care: Interaction between primary care physicians and patients (pp. 115–150). Cambridge: Cambridge University Press.

    Chapter  Google Scholar 

  • Goffman, E. (1974). Frame analysis: An essay on the organization of experience. New York: Harper and Row.

    Google Scholar 

  • Gumperz, J. (1982). Discourse strategies. Cambridge: Cambridge University Press.

    Book  Google Scholar 

  • Gumperz, J. (1992a). Contextualization revisited. In P. Auer & A. di Luzio (Eds.), The contextualization of language (pp. 39–55). Amsterdam and Philadelphia: John Benjamins Publishing Company.

    Chapter  Google Scholar 

  • Gumperz, J. (1992b). Interviewing in intercultural situations. In P. Drew & J. Heritage (Eds.), Talk at work: Interaction in institutional settings (pp. 302–327). Cambridge: Cambridge University Press.

    Google Scholar 

  • Gumperz, J. (1999). On interactional sociolinguistic method. In S. Sarangi & C. Roberts (Eds.), Talk, work, and institutional order: Discourse in medical, mediation, and management settings (pp. 453–471). Berlin and New York: Mouton de Gruyter.

    Chapter  Google Scholar 

  • Hamilton, H., & Chou, W.-Y. (Eds.). (2014). The Routledge handbook of language and health communication, Routledge handbooks in applied linguistics. London and New York: Routledge.

    Google Scholar 

  • Harvey, K., & Koteyko, N. (2013). Exploring health communication. London and New York: Routledge.

    Google Scholar 

  • Heritage, J. (2010). Questioning in medicine. In A. F. Freed & S. Ehrlich (Eds.), “Why do you ask?”: The function of questions in institutional discourse (pp. 42–68). Oxford: Oxford University Press.

    Google Scholar 

  • Heritage, J., & Maynard, D. W. (2006a). Communication in medical care: Interaction between primary care physicians and patients. Cambridge: Cambridge University Press.

    Book  Google Scholar 

  • Heritage, J., & Maynard, D. W. (2006b). Introduction: Analyzing interaction between doctors and patients in primary care encounters. In J. Heritage & D. W. Maynard (Eds.), Communication in medical care: Interaction between primary care physicians and patients (pp. 1–21). Cambridge: Cambridge University Press.

    Chapter  Google Scholar 

  • Heritage, J., Robinson, J. D., Elliott, M. N., Beckett, M., & Wilkes, M. (2007). Reducing patients’ unmet concerns in primary care: The difference one word can make. Journal of General Internal Medicine, 22(10), 1429–1433.

    Article  Google Scholar 

  • Hudak, P. L., Clark, S. J., & Raymond, G. (2012). The omni-relevance of surgery: How medical specialization shapes orthopedic surgeons’ treatment recommendations. Health Communication, 28(6), 1–13.

    Google Scholar 

  • Jepson, M., Salisbury, C., Ridd, M. J., Metcalfe, C., Garside, L., & Barnes, R. K. (2017). The “One in a Million” study: Creating a database of UK primary care consultations. British Journal of General Practice, 67(658), e345–e351.

    Article  Google Scholar 

  • Land, V., Parry, R., & Seymour, J. (2017). Communication practices that encourage and constrain shared decision making in health-care encounters: Systematic review of conversation analytic research. Health Expectations, 20(6), 1228–1247.

    Article  Google Scholar 

  • Major, G. (2014). “Sorry, could you explain that?” Clarification requests in interpreted healthcare interaction. In B. Nicodemus & M. Metzger (Eds.), Investigations in healthcare interpreting (pp. 32–69). Washington, DC: Gallaudet University Press.

    Google Scholar 

  • Mishler, E. (1984). The discourse of medicine: Dialectics of medical interviews. Norwood, NJ: Ablex.

    Google Scholar 

  • Mondada, L. (2016). Operating together: The collective achievement of surgical action. In S. J. White & J. Cartmill (Eds.), Communication in surgical practice (pp. 206–233). Sheffield: Equinox.

    Google Scholar 

  • Pilnick, A., & Coleman, T. (2010). “Do your best for me”: The difficulties of finding a clinically effective endpoint in smoking cessation consultations in primary care. Health, 14(1), 57.

    Article  Google Scholar 

  • Pope, C., & Davis, B. H. (2011). Finding a balance: The Carolinas Conversations Collection. Corpus Linguistics and Linguistic Theory, 7(1), 143–161.

    Article  Google Scholar 

  • Roberts, C., Davies, E., & Jupp, T. (1992). Language and discrimination: A study of communication in inter-ethnic workplaces. London: Longman.

    Google Scholar 

  • Roberts, C., & Sarangi, S. (1999). Hybridity in gatekeeping discourse: Issues of practical relevance for the researcher. In S. Sarangi & C. Roberts (Eds.), Talk, work and institutional order discourse in medical, mediation and management settings (pp. 473–503). Berlin and New York: Mouton de Gruyter.

    Chapter  Google Scholar 

  • Roberts, C., & Sarangi, S. (2005). Theme-oriented discourse analysis of medical encounters. Medical Education, 39(6), 632–640.

    Article  Google Scholar 

  • Roter, D., & Hall, J. (2006). Giving and withholding information: The special case of informative talk in the medical visit. In D. Roter & J. Hall (Eds.), Doctors talking with patients/patients talking with doctors: Improving communication in medical visits (pp. 127–140). Westport, CT: Praeger.

    Google Scholar 

  • Roter, D. L. (1977). Patient participation in the patient-provider interaction: The effects of patient question asking on the quality of interaction, satisfaction and compliance. Health Education Monographs, 5(4), 281–315.

    Article  Google Scholar 

  • Roter, D. L., Hall, J. A., Blanch-Hartigan, D., Larson, S., & Frankel, R. M. (2011). Slicing it thin: New methods for brief sampling analysis using RIAS-coded medical dialogue. Patient Education and Counseling, 82(3), 410–419.

    Article  Google Scholar 

  • Sarangi, S. (2004). Editorial: Towards a communicative mentality in medical and healthcare practice. Communication & Medicine, 1(1), 1–11.

    Article  Google Scholar 

  • Sarangi, S. (2011). Editorial: Contextualising Gumperz. Text & Talk: An Interdisciplinary Journal of Language, Discourse & Communication Studies, 31(4), 375–380.

    Article  Google Scholar 

  • Sarangi, S., & Roberts, C. (Eds.). (1999). Talk, work, and institutional order: Discourse in medical, mediation, and management settings. Berlin: Mouton de Gruyter.

    Google Scholar 

  • Schegloff, E. (1972). Notes on a conversational practice: Formulating place. In D. Sudnow (Ed.), Studies in social interaction (pp. 75–119). New York: Free Press.

    Google Scholar 

  • Stivers, T. (2005). Parent resistance to physicians’ treatment recommendations: One resource for initiating a negotiation of the treatment decision. Health Communication, 18(1), 41–74.

    Article  Google Scholar 

  • Stivers, T., & Rossano, F. (2010). Mobilizing response. Research on Language and Social Interaction, 43, 3–31.

    Article  Google Scholar 

  • Street, R. L., Jr., Makoul, G., Arora, N. K., & Epstein, R. M. (2009). How does communication heal? Pathways linking clinician-patient communication to health outcomes. Patient Education & Counseling, 74(3), 295–301.

    Article  Google Scholar 

  • Street, R. L., Jr., & Millay, B. (2001). Analyzing patient participation in medical encounters. Health Communication, 13(1), 61–73.

    Article  Google Scholar 

  • Stubbe, M. (2017a). Evolution by design: Building a New Zealand corpus of health interactions. In M. Marra & P. Warren (Eds.), Linguist at work: Festschrift for Janet Holmes. Wellington, NZ: Victoria University Press.

    Google Scholar 

  • Stubbe, M. (2017b). Miscommunication at work. In B. Vine (Ed.), The Routledge handbook of language in the workplace (pp. 258–271). London and New York: Routledge.

    Chapter  Google Scholar 

  • Stubbe, M., & De Bres, J. (2009). ‘Patient questions and patient participation: Using mixed methods to analyse longitudinal data. 2nd International Meeting on Conversation Analysis and Clinical Encounters, Peninsula Medical School, University of Plymouth, UK, 20–23 July 2009.

    Google Scholar 

  • Stubbe, M., White, S. J., Macdonald, L., & Dew, K. P. (2016). Do surgeons want to operate? Negotiating the treatment plan in surgical consultations. In S. J. White & J. Cartmill (Eds.), Communication in surgical practice (pp. 124–152). Sheffield: Equinox.

    Google Scholar 

  • Swinglehurst, D., Roberts, C., Li, S., Weber, O., & Singy, P. (2014). Beyond the “dyad”: A qualitative re-evaluation of the changing clinical consultation. BMJ Open, 4(9), e006017.

    Article  Google Scholar 

  • Ten Have, P. (2007). Doing conversation analysis. A practical guide (2nd ed.). London: Sage.

    Book  Google Scholar 

  • Thompson, A. (2007). The meaning of patient involvement and participation in health care consultations: A taxonomy. In S. Collins, N. Britten, J. Ruusuvuori, & A. Thompson (Eds.), Patient participation in health care consultations: Qualitative perspectives (pp. 43–64). Maidenhead: Open University Press.

    Google Scholar 

  • Trenholm, S. (2010). Thinking through communication: An introduction to the study of human communication (6th International ed.). London: Pearson Education Limited.

    Google Scholar 

  • White, S. J., & Cartmill, J. (Eds.). (2016). Communication in surgical practice. Sheffield: Equinox.

    Google Scholar 

  • Zimmermann, C., Del Piccolo, L., Bensing, J., Bergvik, S., De Haes, H., Eide, H., Fletcher, I., Goss, C., Heaven, C., Humphris, G., Kim, Y.-M., Langewitz, W., Meeuwesen, L., Nuebling, M., Rimondini, M., Salmon, P., van Dulmen, S., Wissow, L., Zandbelt, L., & Finset, A. (2011). Coding patient emotional cues and concerns in medical consultations: The Verona coding definitions of emotional sequences (VR-CoDES). Patient Education and Counseling, 82(2), 141–148.

    Article  Google Scholar 

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Acknowledgements

The original research described in Sect. 3 was supported by a grant from the Royal Society of New Zealand Marsden Fund. The authors thank the research participants who generously contributed their data and other members of the ARCH Group who contributed to collecting, transcribing and analysing the illustrative material presented here, in particular Julia de Bres, Libby Plumridge and Rachel Tester.

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Authors and Affiliations

  1. Department of Primary Health Care and General Practice, University of Otago, Wellington, Wellington, New Zealand

    Maria Stubbe, Lindsay Macdonald & Anthony Dowell

  2. School of Social and Cultural Studies, Victoria University of Wellington, Wellington, New Zealand

    Kevin Dew

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  1. Maria Stubbe
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  2. Kevin Dew
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  3. Lindsay Macdonald
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  4. Anthony Dowell
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Correspondence to Maria Stubbe .

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Editors and Affiliations

  1. Department of Linguistics and English Language, Lancaster University, Lancaster, UK

    Gavin Brookes

  2. School of English, University of Nottingham, Nottingham, UK

    Daniel Hunt

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Stubbe, M., Dew, K., Macdonald, L., Dowell, A. (2021). Interactional Sociolinguistics: Tracking Patient-Initiated Questions Across an Episode of Care. In: Brookes, G., Hunt, D. (eds) Analysing Health Communication. Palgrave Macmillan, Cham. https://doi.org/10.1007/978-3-030-68184-5_3

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  • DOI: https://doi.org/10.1007/978-3-030-68184-5_3

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