Conversation Analysis: A New Model of Research in Doctor–Patient Communication

In his much cited 1983 review, David Pendletont strongly criticized existing research on the process of medical consultation. What he meant by process research was research that focuses on what happens during the consultation. Pendleton argued that consultation process descriptions have been 'like the listing of ingredients in a cake without the analysis which shows how to put the ingredients together'. The research that has appeared since Pendleton's critical review indicates that the difficulties are far from overcome. Most of the analyses of doctors' and patients' activities in consultation have applied 'aggregation techniques'2, which operate by coding and counting the frequency of a small number of behaviours such as 'information giving', 'social conversation', 'positive talk' or 'negative talk'3. This approach has drawn attention to various types of activity within the consultation and their possible association with the outcome, for example patient satisfaction. What it seriously lacks, however, is exactly the kind of insight that Pendleton called for 13 years ago an analysis of 'consultation process in terms of social interaction'1 and an ensuing understanding of the consultation as a sequentially organized event. Around the time that Pendleton published his critical review, conversation analytical studies of a new kind began to appear. Reports from Heath4'5, Frankel6'7 and West8'9 raised the hope that conversation analysis could meet exactly the challenge spelled out by Pendleton. (Refs 10-12 offer examples of later developments of conversation analytical studies on medical interaction.) In this paper, I will demonstrate the possibilities that conversation analysis opens up for research on doctor-patient communication.