Doctor's Eye Contact and Patient's Response in Geriatric Triadic Encounters:A Study on Verbal and Nonverbal Interaction

  • 鄭 淑芬

Student thesis: Master's Thesis

Abstract

In recent decades, research on discourse analysis has put emphasis on participants' nonverbal behavior. Eye contact, as one of the nonverbal channels, contributes an important and inevitable role during interaction and has received a lot of scholars' attention. Medical encounters, as one type of social interaction, being significant on information exchange widely emphasize the function of gaze. As a lot of medical textbooks and literatures (e.g., Billings & Stoeckle, 1999; Heath, 1986) have shown, using eye contact as an interviewing skill helps doctors to efficiently elicit patients' information. Doctors are encouraged to maintain their eye contact with patients when they interview them. However, such a facilitating behavior is in conflict with the doctors' act of reading/writing medical records. Doctors' reading/writing records, as an important and inevitable activity in consultation, prevents doctors and patients from maintaining eye contact. Hence, the present study examines how doctors' different gaze patterns affect the verbal interaction. Moreover, the presence of a patient companion might complicate doctors' gaze patterns. Thus, the present study aims to examine doctors' gaze patterns and effects in triadic encounters. My three research questions include: (1) What is the patients' /companions' response rate when doctors gaze towards patients versus towards companions or records? (2) In what ways do doctors’ different degrees of gaze towards patients (i.e., gaze duration) affect patient responses (i.e. in terms of time length and participation amount) to doctors’first open-ended questions? (3) Is silence correlated with doctors’ reading/writing medical records? To examine these questions, the present study collects 24 videotaped medical encounters in the family medicine department of a teaching hospital in southern Taiwan. Each patient accompanied by a family member was visiting their doctor for the first time. The results show that (1) doctors’ eye contact functions as an indicator of who the next speaker might be, as it is shown in my analysis that the party (i.e., the patient, the companion or both) the doctor directs his/her gaze towards while posing a question will be the most probable one to respond to the doctor (i.e., 97.7% by patients, 100% by companions, or 87.2% and 83% by patients and companions respectively); (2) doctors' eye contact is a nonverbal strategy in encouraging patients’elaboratio n. That is, when patients receive doctors' eye contact for more than 60% of the response time (i.e., the time span between the doctor's first open-ended question and his/her second question), their response time and participation amount is larger (i.e., 19.4 seconds, 46.1 syllables) than those patients receiving relatively less eye contact from doctors (i.e., doctors’ eye contact with patients for less than 40% and for 0% of the response time); (3) the absence of doctors' eye contact with the patients (i.e., doctors' reading/writing records) is a potential cause for discontinuation of the conversation (i.e., silence). As the results have displayed that the majority (96.7%) of silence occurs during the moments when doctors are reading/writing records. Based on the above findings, the present study suggests that (1) for doctors to elicit the first-hand information from the patients, they should gaze towards patients when doctors initiate questions, especially in the triadic medical encounter; (2) doctors should maintain their gaze towards patients so that patients will spend more time providing more utterances in reply, especially after doctors initiate their first open-ended question (e.g., what brings you here today?) which aims to elicit a comprehensive perspective of patient problems ; (3) to avoid discontinuity of the conversation flow (i.e., silence), intermittently reading/writing medical records in short periods of time works better than long periods of reading/writing records.
Date of Award2008
Original languageEnglish
SupervisorMei-Hui Tsai (Supervisor)

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