Skip to main content Accessibility help

We use cookies to distinguish you from other users and to provide you with a better experience on our websites. Close this message to accept cookies or find out how to manage your cookie settings.

Close cookie message
×
Hostname: page-component-cd9895bd7-gbm5v Total loading time: 0 Render date: 2024-12-26T22:53:18.053Z Has data issue: false hasContentIssue false

2 - Seeing Silenced Agendas in Medical Interaction: A Conversation Analytic Case Study

Published online by Cambridge University Press:  30 June 2019

By
Merran Toerien  and
Clare Jackson
Edited by
Amy Jo Murray  and
Kevin Durrheim
Amy Jo Murray
Affiliation:
University of KwaZulu-Natal, South Africa
Kevin Durrheim
Affiliation:
University of KwaZulu-Natal, South Africa
Get access

Summary

Conversation analysis (CA) is a paradigm for studying social interaction, investigating talk in its sequential context. The concept of adjacency (the relationship between two turns uttered by different speakers one after the other) is a powerful resource for participants to make sense of what each speaker is doing, both through talk and its absence. This concept enables us to pinpoint the relevant absence of talk of a specific kind. Drawing on three key conversation analytic tools – sequence organization, preference organization and turn taking – this chapter demonstrates how CA can be used to get a handle on the"unsaid." We present a case study from a neurology consultation in which an adult patient’s mother and neurologist work to process their contrasting diagnostic agendas. We demonstrate how CA can reveal (1) what is relevantly absent in a sequence of talk; (2) the unsaid in what is articulated, and (3) the (often subtle) silencing of another through particular interactional "moves." We show that the underlying conflict seldom rises to the surface of the interaction; each speaker attempts to maintain social bonds while s advancing their own objectives.

Keywords

conversation analysissequence organizationpreference organizationturn-takingneurologydoctor-patient interactioninteractional conflictdisagreement
Type
Chapter
Information
Qualitative Studies of Silence
The Unsaid as Social Action
 , pp. 38 - 58
Publisher: Cambridge University Press
Print publication year: 2019

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Bolden, G. B. (2010). ‘Articulating the unsaid’ via and-prefaced formulations of others’ talk. Discourse Studies, 12(1), 5–32.Google Scholar
Button, G., & Casey, N. (1984). Generating topic: The use of topic initial elicitors. In Atkinson, J. M.& Heritage, J. (Eds.), Structures of social action: Studies in conversation analysis (pp. 167–190). Cambridge: Cambridge University PressGoogle Scholar
Chevalier, F. H., & Moore, J. (Eds.). (2015). Producing and managing restricted activities: Avoidance and withholding in institutional interaction (Vol. 255). Amsterdam; Philadelphia: John Benjamins Publishing.Google Scholar
Curl, T. S. (2006). Offers of assistance: Constraints on syntactic design. Journal of Pragmatics, 38(8), 1257–1280.CrossRefGoogle Scholar
Curl, T. S. & Drew, P. (2008). Contingency and action: A comparison of two forms of requesting. Research on Language and Social Interaction, 41(2), 129–153.Google Scholar
Davidson, J. (1984). Subsequent versions of invitations, offers, requests, and proposals dealing with potential or actual rejection. In Atkinson, J. M. & Heritage, J. (Eds.), Structures of social action: Studies in conversation analysis (pp. 102–128). Cambridge: Cambridge University Press.Google Scholar
Dickson, J. M., Peacock, M., Grünewald, R. A., Howlett, S., Bissell, P., & Reuber, M. (2017). Non-epileptic attack disorder: The importance of diagnosis and treatment. British Medical Journal: Case Reports, 2017. Retrieved from http://casereports.bmj.com/content/2017/bcr-2016–218278.abstractCrossRefGoogle Scholar
Drew, P. (2012). Turn design. In Sidnell, J., & Stivers, T. (Eds.), The handbook of conversation analysis (pp. 131–149). Chichester: John Wiley & Sons.Google Scholar
Drew, P., & Heritage, J. (1992). Analyzing talk at work: An introduction. In Drew, P. & Heritage, J. (Eds.), Talk at work (pp. 3–65). Cambridge: Cambridge University Press.Google Scholar
Gardner, R. (1997). The listener and minimal responses in conversational interaction. Prospect, 12(2), 12–32.Google Scholar
Gill, V., & Maynard, D. (2006). Explaining illness: Patients’ proposals and physicians’ responses. In Heritage, J. & Maynard, D. W. (Eds.), Communication in medical care: Interaction between primary care physicians and patients (pp. 115–150). Cambridge: Cambridge University Press.Google Scholar
Goffman, E. (1955). On face-work: An analysis of ritual elements in social interaction. Psychiatry, 18(3), 213–231.Google Scholar
Heritage, J. (1984). Garfinkel and ethnomethodology. Cambridge: Polity Press.Google Scholar
Heritage, J. (2012). Epistemics in action: Action formation and territories of knowledge. Research on Language & Social Interaction, 45(1), 1–29.CrossRefGoogle Scholar
Heritage, J., & Robinson, J. D. (2006). The structure of patients’ presenting concerns: Physicians’ opening questions. Health Communication, 19(2), 89–102.Google Scholar
Heritage, J., Robinson, J. D., Elliott, M. N., Beckett, M., & Wilkes, M. (2007). Reducing patients’ unmet concerns in primary care: The difference one word can make. Journal of General Internal Medicine, 22(10), 1429–1433.CrossRefGoogle Scholar
Jefferson, G. (1972). Side sequences. In Sudnow, D. (Ed.), Studies in social interaction (pp. 294–338). New York: Free Press.Google Scholar
Jefferson, G. (2004). Glossary of transcript symbols with an Introduction. In Lerner, G. (Ed.), Conversation analysis: Studies from the first generation (pp. 13–31). Philadelphia: John Benjamins.Google Scholar
Local, J. K. (2004). Getting back to prior talk: And-uh(m) as a back-connecting device in British and American English. In Couper-Kuhlen, E. & Ford, C. E. (Eds.), Sound patterns in interaction: Crosslinguistic studies of phonetics and prosody for conversation (pp. 377–400). Amsterdam: John Benjamins.Google Scholar
Kitzinger, C. (2000). Doing feminist conversation analysis. Feminism & Psychology, 10(2), 163–193.Google Scholar
Mandelbaum, J. (1991). Conversational non‐cooperation: An exploration of disattended complaints. Research on Language & Social Interaction, 25(1–4), 97–138.CrossRefGoogle Scholar
Mishler, E. G. (1984). The discourse of medicine: Dialectics of medical interviews (Vol. 3). London: Greenwood Publishing Group.Google Scholar
Monzoni, C. M., Duncan, R., Grünewald, R., & Reuber, M. (2011). How do neurologists discuss functional symptoms with their patients: A conversation analytic study. Journal of Psychosomatic Research, 71(6), 377–383.CrossRefGoogle ScholarPubMed
Monzoni, C., & Reuber, M. (2015). Linguistic and interactional restrictions in an outpatient clinic: The challenge of delivering the diagnosis and explaining the aetiology of functional neurological problems. In Chevalier, F. H. G. & Moore, J. (Eds.), Producing and managing restricted activities: Avoidance and withholding in institutional interaction (pp. 239–270). Amsterdam; Philadelphia: John Benjamins Publishing.Google Scholar
Plug, L., Sharrack, B. & Reuber, M. (2009). Seizure, fit or attack? The use of diagnostic labels by patients with epileptic or non-epileptic seizures. Applied Linguistics, 31(1), 94–114.Google Scholar
Pomerantz, A. (1984). Agreeing and disagreeing with assessments: Some features of preferred/dispreferred turn shapes. In Atkinson, J. M. & Heritage, J. (Eds.), Structures of social action: Studies in conversation analysis (pp. 57–101). Cambridge: Cambridge University PressGoogle Scholar
Reuber, M., Chappell, P., Jackson, C., & Toerien, M. (2018). Evaluating nuanced practices for initiating decision making in neurology clinics: A mixed-methods study. Health Services and Delivery Research, National Institute for Health Research Journal’s Library.CrossRefGoogle Scholar
Reuber, M., Toerien, M., Shaw, R., & Duncan, R. (2015). Delivering patient choice in clinical practice: A conversation analytic study of communication practices used in neurology clinics to involve patients in decision-making. Health Service Delivery Research, National Institute for Health Research Journal’s Library, 3(7). Retrieved from http://nets.nihr.ac.uk/data/assets/pdf_file/0017/124901/FLS‐10‐2000‐61Google Scholar
Robinson, J. D. (2003). An interactional structure of medical activities during acute visits and its implications for patients’ participation. Health Communication, 15(1), 27–59.CrossRefGoogle ScholarPubMed
Robinson, J. D. (2006). Soliciting patients’ presenting concerns. In Heritage, J. & Maynard, D. (Eds.), Communication in medical care: Interactions between primary care physicians and patients (pp. 22–47). Cambridge: Cambridge University Press.Google Scholar
Robson, C. M. & Lian, O. S. (2016). ‘Are you saying she’s mentally ill then?’ Explaining medically unexplained seizures in clinical encounters. Forum Qualitative Sozialforschung/Forum: Qualitative Social Research, 17(1). Retrieved from https://doi.org/10.1080/17482631.2017.1392219Google Scholar
Sacks, H. (1987). On the preferences for agreement and contiguity in sequences in conversation. In Button, G. & Lee, J. R. E. (Eds.), Talk and social organisation (pp. 54–69). Clevedon: Multilingual Matters.Google Scholar
Sacks, H., Schegloff, E. A., & Jefferson, G. (1974). A simplest systematics for the organization of turn taking in conversation. Language, 50, 696–735.CrossRefGoogle Scholar
Schegloff, E. A. (1987). Analyzing single episodes of interaction: An exercise in conversation analysis. Social Psychology Quarterly, 50(2), 101–114.Google Scholar
Schegloff, E. A. (1988). Goffman and the analysis of conversation. In Drew, P. & Wootton, A. (Eds.), Erving Goffman: Exploring the interaction order (pp. 89–135). Cambridge: Polity Press.Google Scholar
Schegloff, E. A. (1996). Confirming allusions: Toward an empirical account of action. American Journal of Sociology, 104(1), 161–216.Google Scholar
Schegloff, E. A. (1997). Whose text? Whose context? Discourse & Society, 8(2), 165–187.CrossRefGoogle Scholar
Schegloff, E. A. (2007). Sequence organization in interaction: Vol. 1: A primer in conversation analysis. Cambridge: Cambridge University Press.Google Scholar
Schegloff, E. A., & Sacks, H. (1973). Opening up closings. Semiotica, 8(4), 289–327.Google Scholar
Schneider, J. W., & Conrad, P. (1980). In the closet with illness: Epilepsy, stigma potential and information control. Social Problems, 28(1), 32–44.Google Scholar
Stivers, T. (2001). Negotiating who presents the problem: Next speaker selection in pediatric encounters. Journal of Communication, 51(2), 252–282.CrossRefGoogle Scholar
Stivers, T. (2002). Presenting the problem in pediatric encounters: ‘Symptoms only’ versus ‘candidate diagnosis’ presentations. Health Communication, 14(3), 299–338Google Scholar
Stivers, T., & Heritage, J. (2001). Breaking the sequential mold: Answering ‘more than the question’ during comprehensive history taking. Text–Interdisciplinary Journal for the Study of Discourse, 21(1–2), 151–185.CrossRefGoogle Scholar
Stivers, T., & Rossano, F. (2010). Mobilizing response. Research on Language and Social Interaction, 43(1), 3–31.Google Scholar

Save book to Kindle

To save this book to your Kindle, first ensure [email protected] is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about saving to your Kindle.

Note you can select to save to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be saved to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

Find out more about the Kindle Personal Document Service.

Available formats
×

Save book to Dropbox

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Dropbox.

Available formats
×

Save book to Google Drive

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Google Drive.

Available formats
×