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Conversation Analysis

4. CA and the Medical Encounter

A rather different issue of lexical choice is evident in the next example. Here a mother is presenting her eleven year old daughter's upper respiratory symptoms. The time is Monday afternoon, and the daughter has not attended school. The mother begins with a diagnostic claim (lines 1-2, 5) which strongly conveys her commitment to the veracity of her daughter's claims about her symptoms, and may imply the relevance of antibiotic treatment (Stivers, 2002; 2007).


The clinician begins to take a history at line 18 and, in the absence of a response from the child patient, the mother asks when her daughter "noticed" her symptoms. This verb conveys a quite distinct notion of attention and cognition. It suggests that the child's perception of her symptoms emerged in an unlooked for and, hence, unmotivated way. Its use is one of several ways in which the mother conveys her commitment to the factual status of her daughter's symptoms, and especially works against any possibility that they were fabricated as a means of not attending school -- an issue that can hang heavily over Monday visits to the pediatrician! Subsequently the mother distinguishes between the child's noticing her symptoms and ”mentioning” them - thus opening up the possibility that the child has endured them for longer than 24 hours, which would further underwrite the unmotivated nature of their discovery and report. Here then what is at issue is how the 'discovery', and the process of the coming to recognize, 'medical symptoms' is to be portrayed (see Halkowski (2006) for an extended discussion of this subject).

Here then are four broad levels at which the analysis of doctor-patient interaction can proceed. Each one is significant and consequential for the meaning-making process that is the medical encounter.

  • Overall phase structure
  • Sequence organization
  • Turn design
  • Lexical choice

The four levels are nested within one another and in practice all four levels may be involved in the analysis of actual episodes of interaction.

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Stivers, T. (2007). Prescribing under pressure: Parent-physician conversations and antibiotics. New York: Oxford University Press.
Halkowski T. (2006). Realizing the illness: Patients' narratives of symptom discovery. In: Heritage J., Maynard D., Ed,  Communication in medical care: Interactions between primary care physicians and patients. Cambridge, UK: Cambridge University Press, 8