Communication in medical care

The book by Heritage and Maynard is very useful if you are interested in Conversation Analysis and communication in health settings, and it shows how qualitative and quantitative studies may be usefully intertwined.

[...] respect for alternative methods does not preclude combining methods to maximize discovery and insight. (xiii)

Despite the fact I am carrying out investigations on the role of community interpreters, rather than of physicians and patients, this book proved to be extremely helpful for my research.

In particular, by stressing the importance of doctor-patient communication, it made me aware of the fact that physicians may address their patients in different ways, and that this may have consequences on the relationship between the two.

The doctor may, for instance, ask questions more or less directly, and consequently obtain more or less trouble-resistant responses (p. 75).

If it is true that doctors may choose their “ways” among a wide range of possible utterances, let us imagine what happens when an interpreter is there between doctor and patient, choosing as well among a wealth of possibilities. And let us imagine what may happen, in the doctor-patient relationship, if the interpreter was not aware of the value, and consequences, of every single utterance made by the doctor and by him/her self.

That’s Food for though, I would say.

The same is for a number of other suggestions contained in this book, which I will briefly note here for the sake of memory (yours and mine as well). My personal thoughts are into square brackets.

- The “voice of medicine” may overlap with the “voice of the life world” in the narrative of problem discovery (p. 115)

- Questioning during history-taking may be something more than simply eliciting information (p. 151)

- Difference between close-ended and open-ended questions (p. 157)

- Importance of body work [hence it may be worth video recording!]

- Analysis of diagnostic statements in terms of types and position of diagnostic utterances (p. 217)

- Quantitative analysis may be helpful to asses the robustness of the qualitative conclusions (p. 217)

- Ways of delivering “bad” and “good” news (p. 248)

- Possible distinction between major and minor conditions (p. 256) [it may be helpful to tag them in my corpus, then]

- Prescriptions (p. 315) [how can interpreters handle drug names?]

- Issues of lifestyle, such as diet, drinking, smoking and exercise, may play a role in the interview (p. 343)
[It may be worth tagging these issues in the corpus, so as to run queries on lexis]

- Existing literature suggests that talking about lifestyle may be rather different in different countries (p. 341) [Given that I am aiming at a trilingual corpus it may be worth taking this aspect into consideration]

I could go on for ages talking about this book, since it is very dense and stimulating. I will however conclude by stressing once more the two reasons why  the book is in my opinion worth reading:

1) It shows you how qualitative and quantitative analysis may be usefully intertwined.
2) It describes the different stages and elements of doctor-patient communication, hence providing interpreters with a thorough account of what they may have to deal with.

Heritage, J. & D.W. Maynard (2006). Communication in medical care. Cambridge: CUP

One Response to “Communication in medical care”

1. Francesco scrive:

   29 marzo 2009 alle 16:08

   Ciao Nat ho trovato questo interessante link che spero possa esserti utile
   http://www.intermed.interpreters.it/