The closing stage in medical encounters is the final stage for doctors and patients to negotiate the perspective from present events to a future orientation (White et al, 1997). Closing stages are not only a crucial stage for both doctors and patients to build up a positive relationship but also the last chance to solve problems. Often, due to the agenda of patients’ and the authorized higher power status of the doctor, sometimes these additional concerns, along with the chief complaint are difficult to follow. Additionally, unlike western medical environment in which the doctor will leave the examining room before the patient does, in Taiwanese medical encounters, patient comes and goes while the doctor is in the examining room preparing for the next patient’s visit. The doctor has the home court advantage in medical encounters. Therefore, the nature of power asymmetry may become the patient’s agenda thus makes the patient fail to reveal all the concerns. Patients’ agenda and the asymmetric power relationship may cause concerns unresolved. Since the essential purpose of medical encounters is to resolve the concerns from patients and to contribute to a good health outcome, successfully resolving concerns through communication skills in medical encounters is a crucial issue worth following. However, clear linguistic elements and discourse positions which signal the closing stages still remain unclear. For improving diagnosis and achieving a patient-centered medical environment, the study follows previous studies to examine the interactions between doctors and patients in the closing stages in medical encounters because every second in an encounter is important. The aim of this study is indicating the linguistic elements reflect the interaction between doctors and patient parties in closing stages and how the participants achieve the mutual acceptance of closing. In order to demonstrate it, the first description of closing stages needed to be pinned down in advance. Hence, the first focus of the current study is (1) how the closing stages in Taiwanese medical encounters are structured? (2) what linguistic elements may cause the doctor to reopen the previous seeking stage to solicit the unresolved concern? Third, (3) in institutional settings, in a way to negotiate the closing of the encounter, what are the linguistic elements that signal the confirmation for participants that they are in the same perspective and ready to leave? An observation of the interaction in closing stages of Taiwanese medical encounters is presented in this study based on the analyzing approaches proposed by Schegloff & Sacks (1973) and White et al (1997). By analyzing 30 cases that were collected in the department of family medicine at a medical teaching hospital in southern Taiwan, the finding shows that closing stages in medical conversations is constituted by pre-closing and closing sequences jointly in Taiwanese medical closing stages. Linguistic elements that are used as materials to warrant a closing are as following: (1) pre-closing sequences: (a) preparation (b) final-notification; (2) closing sequences: (c) mutual acceptance. Moreover, the first finding shows the main initiator of preparation in the negotiation of closing is mostly the doctor (97%). And doctors actively take the leading position in current interaction by using final notification (43%). The finding provides us an overview of pre-closing sequences in the closing stages in Taiwanese medical encounters. Second finding shows that the unresolved concerns which are brought up after a preparation are closing resistance. When it occurs (30%), it may cause the doctor an effort to reopen the information seeking stage. We concluded closing resistance represents an approach for the patient parties to take control of the turn of talking hence to extend the interaction and resolve their concerns. Third, closing sequence occurs after pre-closing sequence and before the actual end point in an encounter. We found linguistic elements such as goodbye phrase (20%) and thanking (80%) are used as mutual acceptance in closing sequences in Taiwanese medical encounters. Goodbye phrase and thanking demonstrate a unit of closing sequence and signal a completion of the current interaction. The findings indicate that linguistic elements (pre-closing and closing sequences) found in closing stages are mostly used by medical staffs; in terms of that dominators in closing stages are still medical staffs. Further, the opportunity for patient parties to extend and control the interaction is rare (30%). In which the asymmetrical power status between doctors and patients seems easily seen in closing stages. Since to detect and assist the patient parties to fully express their concerns is important, acknowledging patient parties’ approach to express their concerns is a crucial issue in present study. The study also indicates that a task-oriented approach is still the mainstream even in the final phase in Taiwanese medical encounters. Moreover, the unrevealing agendas of participants may decrease the effectiveness of medical encounters, or cause the psychological pressure of the patient. Hence, problem resolving and rapport building are both worth achieving in every stage in medical encounters.
|Date of Award||2012|
|Supervisor||Mei-Hui Tsai (Supervisor)|