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Conversation Analysis

4. CA and the Medical Encounter

Turn Design

At a further level of detail, the actions that are built into sequences must be implemented in turns at talk.

Turns are the objects of design and selection which are communicative and revealing.

Example 5

Early in a British community nurse's first home visit to a primiparous mother, the nurse, apparently noticing the baby chewing on something, initiates the following exchange Drew and Heritage (1992):

Here the nurse's comment attracts very different responses from the child's parents. The father's turn is entirely occupied with agreeing with the nurse's observation. The mother's response however, by treating the nurse as implying that her child is hungry, embodies a defense against this implication and is infused with laugh particles which are often associated with such responses (Haakana, 2001).

Similarly in the following sequence, which occurs less than a minute later in the encounter, the following occurs (Drew and Heritage, 1992):

While both husband and wife design their responses as agreements with the nurse at the arrowed turns, the design of those agreements is quite different. The father (lines 6 and 8) agrees with reference to their own child, and indicates that they have started to notice the rapid development that the nurse mentions. The mother is more guarded. She makes no reference to her own child, confining her agreement to the learning capacities of children in general.

It is tempting to suggest that a relatively conventional sex-role division of labor informs both of these sequences. The father, who may have little responsibility for the day to day care of the child, is inclined to agree in an open-hearted way with the nurse, and even to claim a little credit for having noticed things that the nurse – the accredited 'baby expert' – comments on. The mother, with overall responsibility for the child, may encounter the nurse's expertise as a threat to her own, and to resent the 'surveillance' that is the unavoidable concomitant of a series of home visits (Heritage and Sefi, 1992).

Drew P., Heritage J., Eds. (1992). Talk at work: Language use in institutional and work-place settings. Cambridge, UK: Cambridge University Press.
Haakana M. (2001). Laughter as a patient's resource: Dealing with delicate aspects of medical interaction. Text 21(1): 187-219.
Drew P., Heritage J., Eds. (1992). Talk at work: Language use in institutional and work-place settings. Cambridge, UK: Cambridge University Press.
Heritage J., Sefi S. (1992). Dilemmas of advice: Aspects of the delivery and reception of advice in interactions between health visitors and first time mothers. In: Drew P., Heritage J.,Ed,  Talk at work. Cambridge, UK: Cambridge University Press, 359-4