Conversation Analysis

5. CA in Action

Example 8c

The next phase of this sequence will be easily recognizable to those who have read Elliot Mishler's The Discourse of Medicine (1984). In that study, Mishler elaborated a distinction between what he called the ‘voice of medicine’ preoccupied with objectivity and measurement, and the ‘voice of the lifeworld’ preoccupied with personal experience. Mishler depicted these two orientations as frequently in conflict, and so they are here. The clinician pursues a measurable metric for the patient's alcohol use by asking "Daily do you use alcohol or:=h". The question invites the patient to agree that she uses alcohol on a daily basis, thereby permitting her to take a step in the direction of acknowledging a 'worst case scenario' (Boyd and Heritage, 2006). The movement of the word "daily" from its natural grammatical position at the end of the sentence to the beginning, has the effect of raising its salience, presenting a frequency estimate as the type of answer he is looking for. Finally, the 'or' at the end of the sentence, invites some other measure of frequency, and thereby reduces the physician's emphasis on 'daily' as the only possible (or most likely) response for the patient to deal with.

Boyd E., Heritage J. (2006). Taking the history: Questioning during comprehensive history Taking. In:  Heritage J., Maynard D., Ed,  Communication in Medical Care: Interactions between Primary Care Physicians and Patients. Cambridge, UK: Cambridge Unive