Abstract
In this article, we qualitatively explore the manner and style in which medical encounters between patients and general practitioners (GPs) are mutually conducted, as exhibited in situ in 10 consultations sourced from the One in a Million: Primary Care Consultations Archive in England. Our main objectives are to identify interactional modes, to develop a classification of these modes, and to uncover how modes emerge and shift both within and between consultations. Deploying an interactional perspective and a thematic and narrative analysis of consultation transcripts, we identified five distinctive interactional modes: question and answer (Q&A) mode, lecture mode, probabilistic mode, competition mode, and narrative mode. Most modes are GP-led. Mode shifts within consultations generally map on to the chronology of the medical encounter. Patient-led narrative modes are initiated by patients themselves, which demonstrates agency. Our classification of modes derives from complete naturally occurring consultations, covering a wide range of symptoms, and may have general applicability.
Highlights
Based on a qualitative analysis of 10 naturally occurring primary care consultations in England, we explore the ways in which medical encounters are conducted in situ as a collaborative enterprise
We identified five distinctive interactional modes in our data: question and answer (Q&A) mode, lecture mode, probabilistic mode, competition mode, and narrative mode
The classification is based on the types of speech acts the dialogues entail. This is contrary to existing categorizations of doctor–patient interactions, which usually are based on normative categories, often with “paternalistic” included, for instance “paternalistic”, “informative”, “interpretive”, and “deliberative” (Emanuel & Emanuel, 1992), as well as the more recent classification of “controlled”, “constrained”, and “flexible” (Franklin et al, 2019)
Summary
Based on a qualitative analysis of 10 naturally occurring primary care consultations in England, we explore the ways in which medical encounters are conducted in situ as a collaborative enterprise. Our research team is interdisciplinary (sociology, medicine, and philosophy), but our main analytical approach is sociological Most importantly, this means situating doctor–patient interactions within the wider sociocultural contexts, which invariably permeate medical consultations, and exploring the relationship between the practice and the social field in which it is embedded. The two main positions—doctor and patient—are complementary and asymmetrical By virtue of their location in the social structure, doctors have an institutionally based authority position. When entering their positions in this field, actors become responsive to the preset repertoire of culturally shared norms and values they are expected to act upon. Because of the “social genesis” of these rules, actors can choose to honor, invert, or disregard them (Strong, 1979)
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