A Conversation Analysis Of Accounting For Reasons In Clinic Interaction

According to an anonymous New Zealand Primary Care Physician,"In order to have the privilege of talking to your doctor, you must fulfill the essential precondition of being sick. Then you may go to him and ask him if he will perform his professional services upon you."With the emergence and development of conversation analysis, many scholars have not only paid attention to daily conversations, but also applied basic CA ideas to the medical interview. However, the majority of them have only focused on conversations between two parties, especially on doctors’side. Few researchers have specialized in studying effects of patients’giving reasons for seeking medical care in clinic interaction, which is a common phenomenon in China. So the present study focuses on patients’ accounting for reasons is of great practical significance.With the application of conversation analysis, this thesis aims at studying effects of patients’ accounting reasons for visits, focusing on how patients’ descriptions of their medical problems are designed to manage the social accountability of their decision to visit physicians and, in particular, to justify the decision to seek medical care.Based on the tape-recordings and transcriptions of naturally occurring doctor-patient conversations in Chinese outpatient clinics, this thesis presents general forms of patients’ giving reasons for seeking medical care, the turn design of this kind of conversation in different clinical interviews and the doctors responses displayed as relevant sequence organization. In the following chapter, this thesis describes three descriptive practices which patients use in contexts where justifying the medical visit seems to be clearly at stake. These involve (1) making diagnostic claims,(2) invoking third parties as part of the decision-making process, and (3) doctors making illness explanations.Evidently, the process of justifying the visit does not end with the problem presentation. Similar concerns clearly manifest themselves during the history-taking process and the emergence of these concerns during the process of diagnosis. Nonetheless, the problem presentation phase is the first, and perhaps the most crucial, phase of the encounter for the credibility and legitimacy of patient concerns. It is for this reason, perhaps, that so many issues that bear on the legitimacy of the patient’s presence in the physician’s office are dealt with at this moment, and why the appropriate management of this phase of the visit by the physician is of such central importance.At the end of this thesis, the author poses the limitations of the present study and the suggestions for future research.