Discourse Contexts and Mechanisms Relevant to Elderly Patients’ Presentation of Psychosocial Concerns--A Case Study Based in the Family Medicine Practice in Taiwan

Abstract

Soliciting patients’ psychosocial concerns (e g unemployment or divorce) during the medical interview not only enhances doctor-patient relationship but facilitates the doctor’s diagnosis as well Information regarding patients’ psychosocial concerns helps doctors clarify whether the psychosocial status is a causative or aggravating factor for patients’ physical discomfort However it appears to be a challenging task for most doctors to lead patients to reveal this sort of information since patients might not be aware of the connection between psychosocial status and physical discomfort or might feel reluctant to voice their psychosocial problems With the discourse data of medical interviews between family doctors and their elderly patients this study examines the discourse mechanisms prior to patients’ presentation of psychosocial concerns and patients’ response in the negative (‘無啦/no’) when doctors engage in psychosocial issues The aim of our research focuses on the interaction between family doctors and elderly patients and investigates what discourse contexts and mechanisms are relevant to patients’ revelation of psychosocial concerns The main findings include the followings First patients seldom voluntarily initiate a topic of psychosocial issue and provide psychosocial concerns (14%) Most of the psychosocial concerns are presented following the negative psychosocial atmosphere created in doctors’ utterances (86%) Second the discourse mechanisms that create such negative atmosphere include the concurrent use of ‘time accumulation’ and ‘semantic accumulation’ In other words it involves several turn takes in the conversation and the sequential use of prompts i e doctors start from the use of neutral prompt (‘I would like to know what you are thinking about when you fail to fall asleep at night’) to the use of general-negative (‘have you been troubled recently?’) or specific-negative prompts (‘did the idea of suicide ever come to you’) Third the concurrent mechanisms of ‘time accumulation’ and ‘semantic accumulation’ in doctors’ utterances reflect both the professional doctors and the general public’s perception and expectation that ‘the presentation of psychosocial information is preceded by the biomedical information in medical interviews’ These perception and expectation lead to the discourse pattern that ‘patients’ psychosocial concerns are presented via a topic of biomedical issue’ The implication of the above findings for doctor-patient communication is addressed in the following During medical interviews the negative psychosocial atmosphere created in doctors’ utterances through the mechanisms of time accumulation and semantic accumulation i e ‘collecting psychosocial concerns under the guise of biomedical issue encourages patients to unveil their psychosocial status

Date of Award	2015 Feb 5
Original language	English
Supervisor	Mei-Hui Tsai (Supervisor)