- The dynamic consultation: A discourse analytical study of doctor-patient communication by Marisa Cordella
A special form of talk, the doctor-patient conversation, persistently holds scholars’ attention. Basic questions Cordella pursues include: What do patients and doctors have to say; what is accomplished; and how is power distributed and experienced in the interaction? This analysis of medical consultations is set in a public clinic outside Santiago, Chile.
The study is presented in ten chapters with appendices. The first chapter lays out the book’s contents. Ch. 2, ‘Discourse, society and doctor-patient communication’, reviews a range of pertinent literature, establishing an interactional analytic framework, including a concise consideration of ‘footing’ in conversations. C then explores theories of power, foreshadowing her analysis of interactions. The chapter concludes with a comparison of social scientific and linguistic approaches to the analysis of medical encounters, organized as ‘the doctor’s perspective’ and ‘the patient’s perspective’. Ch. 3, ‘Doctor-patient communication: An empirical study’, details the study’s methodology and introduces the participants: four doctors in combination with twenty-two patients. C points often to gender as a causal factor in her discussion, though data supporting the analysis on gender could be stronger—two of the doctors are male and two female; however, both of the female doctors had been in practice less than five years while both of the male doctors had been in practice more than ten years. One of the female doctors was only recorded with female patients, restricting the analyses of female doctor-male patient dyads to only three, all including the same doctor.
Chs. 4, 5, and 6 treat the doctors’ ‘voices’: the doctor voice, the educator voice, and the fellow human voice. A ‘voice’ here encompasses several patterns of functions, each demanding a unique discourse strategy. The doctor voice, for example, employs questioning patterns and uses of personal pronouns to seek information, assess and review data, and align the conversation to medical authority. The fellow human voice, by contrast, shows empathy and encourages the patient to tell his story. For each voice C presents descriptive statistics on its use by each doctor, along with helpful flow charts that detail conversational markers present in each discourse, function, and voice.
Ch. 7 presents four patients’ voices: health-related storytelling, competence, social communicator, and initiator, each with unique relationships to patient gender, doctor gender, and doctor voice. The ‘dynamic consultation’ of the work’s title is achieved in the give and take between doctor and patient, each playing across a range of voices.
Ch. 8, ‘Patterns of footing’, presents changing stances found in consultations, providing theory with which to interpret empirical data on interactions between doctors’ and patients’ voices. Ch. 9, ‘The dynamic consultation’, returns to issues of power dynamics between doctor and patient, using descriptive data to illustrate HOW power is wielded and resisted in the microinteraction of the consultation. Ch. 10, ‘Concluding remarks’, reiterates the fact that the patient-doctor interaction is dynamic and fluid, and elaborates on practically relevant lessons and areas for further research to improve care. C includes as appendices a word-count chart for recorded consultations, English and Spanish versions of questionnaires distributed to doctors and patients, transcription symbols, and English and Spanish versions of the consent forms for the study.