A Conversation Analytic Study Of Medication Request In Doctor-Patient Interaction

Making request is a common social behavior in everyday life.Previous studies have explored it from many perspectives,such as pragmatics,sociology,psychology and so on.There are also some studies on requests from the perspective of conversational analysis.Compared with those studies based on isolated and invented utterances,conversation analysis can truly reveal the process of requests based on naturally-occurring conversations.In addition,after reviewing previous studies of doctor-patient interaction under the Chinese healthcare system,it is found that there are no studies on medication requests in Chinese township hospitals so far.Based on the data analysis of 227 video recordings of naturally-occurring conversation that occurs between doctors and patients,this study aims to explore the strategies,overall structure and sequence organization of medication requests in doctorpatient interaction.The research tries to answer the following questions:(1)What strategies are employed by patients to make medication request?(2)What are the sequential characteristics of patients’ medication requests?(3)How to interpret patients’medication requests from the perspective of epistemics?The major findings of the study are as follows:(1)Patients employed not only verbal resources but also nonverbal resources when making medication requests.Based on the resources used by the patients,3 types of medication request strategies were identified:general verbal request,verbal request with embodied action,and embodied action as request.Within each of these 3 types of medication request strategies,there were 3 sub-strategies:verbal request alone,verbal request with symptom,verbal request with medicine name;verbal request with handing card,verbal request with handing medicine packages,verbal request with handing card and medicine package;handing card alone,handing package alone,handing card and medicine packages.(2)By investigating patient-initiating medication requests,it was found that there are insert sequences and post sequences as expansions from base sequences.The insert sequences are relevant to medicine confirmation and the post-sequences are concerning requests for cards.As for doctors-initiated patients’ medication requests,it was found that post sequences commonly occur.The number of post sequences may be related to the medication request strategy adopted by the patient.(3)Through performing information request about medicine and getting information from the doctor,the patient has shifted his or her epistemic status from the K-to K+.From the perspective of epistemic primacy,the patient tends to downgrade his or her epistemic primacy while the doctor intends to upgrade his or her epistemic primacy with questions.Expressions like Which kind and What are respectively used by the doctor and the patient to ascribe the failure to take epistemic responsibilities to the other side.This study not only enriches the exploration of request strategies and the organization of request sequences with verbal and nonverbal resources but also enlarges the study of requests from the perspective of epistemics,which can provide enlightenment to both doctors and patients in reducing the communication barriers and improving doctor-patient communication in township medical hospitals.