Talking about Treatment: Recommendations for Breast Cancer Adjuvant Therapy (review)

Felicia Roberts’s articulate and highly readable conversation analysis of oncology visits provides a fresh perspective on doctor/patient roles and the structuring power of discourse within clinical settings. Instead of accepting that greater power is intrinsic to doctors, R views participant roles and interactional outcomes as emerging through participants’ language behavior, through their ‘talk-in-interaction’ (3). R refers to these discursive formations as cooperative constructions, and it is an analysis that echoes theories of language performativity.

Adding to the body of scholarship on communicative practices in general medicine, this study focuses specifically on the organization of turns and content within an oncology visit, and on the structure, delivery, and reception of doctor recommendations. Ch. 1 (3–17) provides a clear and succinct overview of the research concerns and relevant literature. Here, R also introduces her critical argument that expertise is not an institutionally available role but a mutually constructed identity within particular conversations. Ch. 2 (18–24) outlines the study methodology (conversation analysis) and the data collection and analysis. Ch. 3 (25–49) uses the phase framework established by Patrick Byrne and Barrie Long (Doctors talking to patients: A study of the verbal behaviors of general practitioners consulting in their surgeries, London: HMSO, 1976) as a means of describing and analyzing the structure of the oncology visits. Noting that two of the initial phases—determining the reason for the visit and taking a medical history—were technically unnecessary in the context of these referral appointments, R concludes that these initial phases, rather than introducing new information, help to establish the doctor as advice-giver and the patient as advice-recipient.

Ch. 4 (50–73) further explores this role-creation as part of the function of the discourse between doctor and patient. R contends that doctors are experts not because of their specialized knowledge but because of its display and of the control they exert over the conversation (gatekeeping maneuvers). Ch. 5 (74–103) takes up the recommendation for treatment itself. Extended discussion surrounding the recommendation, R argues, serves both to explain and justify a particular treatment option and to persuade the patient to choose that option. Ch. 6 (104–10) concludes by suggesting areas for further research, ways to pursue the argument that doctor/patient roles are cooperatively created through talk-in-interaction.

R’s study is remarkably silent on issues of gender and other demographic influences on participant roles, but this is likely due to the restricted size of the data sample and to R’s focus on describing the prototypical oncology visit. Nevertheless, this study will be of interest to scholars of medical communication as well as to conversation analysts more generally. R clearly explains and highlights the transcripts she includes in her text and provides a compelling baseline for further investigation into the complex discursive interactions between doctors and patients.