Doctors' orientation to patients' problem presentation in primary care - Implications to overall structure of medical consultation

Taru Hannele Ijäs

University of Tampere, Dept. Sociology and Social Psychology, Finland


Doctors’ orientation to patients’ problem presentation in primary care –

Implications to overall structure of medical consultation

This presentation focuses on the interactional consequences of the ways in which patients formulate their initial problem presentations in the medical consultation. It will be examined how doctors orientate to patients’ and parents’ problem presentations and how such orientation shapes the conduct and the overall structure of medical encounters.

We will present preliminary results of an analysis in which we have compared different types of patients’ problem presentations to each other. We will show how doctors, through their practices of talk-in-interaction, both acknowledge the agenda that the patients set in their problem presentation and use the conventional, overall structure of medical consultation as their interactional resource in doing so. The results of the study contribute to the discussion on patient participation and doctor- vs. patient-centredness as actual, clinical practices and interactional phenomena: the analysis shows how social organization of medical consultation is achieved and constructed as a result of both context-shaped and context-renewing practices of interaction and suggests that the institutional relationship between a doctor and a patient is primarily reflexive in its character.

The analysis is a part of Ijäs' doctoral dissertation “Negotiation on treatment decision in primary care”. The data consist of 90 primary care acute visits with adult and child patients suffering from upper respiratory tract infections and is collected from 11 physicians in municipal health care in Finland in the years 2005-6. The method of the study is conversation analysis.

Session: Paper session
Language/medical 1
Thursday, April 3, 2008, 10:30-12:00
room: 07