MADISON – An international group of conversation analysts has put together a new
anthology of studies that explore communication between primary-care doctors and
their patients.
Douglas Maynard, a professor of sociology at the University of Wisconsin-Madison,
co-edited the new book titled “Communication in Medical Care: Interaction Between
Primary Care Physicians and Patients.” Published earlier this year by Cambridge
University Press, the volume will be on view during the 101st annual meeting of the
American Sociological Association in Montreal, to be held Friday-Monday, Aug. 11-14.
“This is the first time there has been a book that anatomizes the primary-care
interview from start to finish,” says Maynard, who has dissected conversations in
various arenas for more than 25 years.
Thinking about doctor-patient interaction is crucial at a time when medical schools
are increasingly aware of the need for fruitful interactions between primary
caregivers and their patients. Several schools now require students to pass an exam
evaluating interaction skills. Meanwhile, medical residency programs are beginning
to recruit residents with at least some communication training.
The book targets sociologists, communication experts and medical professionals, and
ultimately aims to understand the social organization of medical talk while helping
to improve doctor-patient relationships, Maynard says. The sociologist co-edited the
anthology with John Heritage, a professor of sociology at the University of
California, Los Angeles.
Eighteen researchers from the United States, the United Kingdom and Finland
contributed chapters to the book, each analyzing different aspects of the
doctor-patient interview. One chapter examines how physicians record patient medical
histories, for example, while another analyzes discussions between a doctor and
patient about treatment options.
Another chapter, co-authored by Maynard, examines conversations in which physicians
announce both bad and good news. Maynard says that is a departure from earlier
studies in which researchers primarily focused on doctors delivering bad news, such
as a terminal diagnosis or the announcement of a patient’s death to family members.
Yet, good news can also be problematic in some cases, such as when a patient
continues to experience symptoms, even though the doctor has detected no sign of
disease.
The book’s contributors gleaned insights about communication in the doctor’s office
through video clips and audio recordings – and the help of very detailed
transcripts. Conversation analysts are trained to pick up telling clues from even
the tiniest nuance in a verbal exchange. And sometimes, what is not said is almost
as important as what is. “Silences in conversations are extremely important,”
Maynard says. “We actually time them, in tenths of a second.”
“Communication in Medical Care” does not mark the first time researchers have
thought about doctor-patient interactions, but it is the first time experts have
studied in detail the behaviors of both the doctor and the patient, and how the two
interrelate.
“Previous work on doctor-patient relationships focused much more on the physicians
and what they should or should not do,” says Maynard. “But our book is among the
first to study how the physician and the patient together contribute to an
interaction.”
